肾移植受者围手术期危急值分析与处理

Analysis and management of critical value in renal transplantation recipients during perioperative period

目的分析并总结肾移植受者围手术期常见危急值的特点及处理方法。方法收集出现危急值的273例次肾移植围手术期患者的性别、年龄、危急值、原发病、出现危急值时临床诊断及相应处理等资料并进行分析。结果与结论肾移植受者在围手术期危急值以水、电解质和酸碱平衡紊乱最为常见,占43.2%(118/273),其中高钾血症最常见,占24.9%(68/273);出现危急值的男性比例高于女性(76.9%比23.1%),且多集中于35~54岁年龄段。对于出现高钾血症危急值患者,依次使用葡萄酸钙或氯化钙稳定心肌细胞膜、胰岛素、葡萄糖以及碳酸氢钠静脉滴注促使K+向细胞内转运、利尿药促进K+排泄,上述治疗无效则采用血液透析进行治疗。所有患者血钾均恢复正常。对出现其他危急值的患者,则针对不同情况采取个体化治疗措施。了解肾移植受者围手术期常见危急值,以及不同年龄段、不同性别的肾移植受者危急值分布的特点和原因,对临床监测和治疗有较强的指导作用。

Objective To analyze and summarize the and charcteristics and processing methods of critical value in renal transplantation recipients during perioperative period. Methods Clinical data including gender, age, critical value, primary disease, clinical diagnosis and corresponding management at the presence of critical value in 273 cases with renal transplantation were collected and analyzed during perioperative period. Results and conclusions During perioperative period, the critical values of water, electrolyte and acid-base disorders were observed in 43.2% （118/273） of renal transplantation cases. The hyperpotassemia was found in 24.9% （68/273） of cases, which was the most common critical value. The percentage of male patients presenting with critical value was 76.9%, significantly higher compared with 23.1% in female counterparts, especially in those aged 35 to 54 years. For patients with critical value of hyperpotassemia, calcium gluconate or calcium chloride was administered to stabilize myocardium cell membrane. Insulin, glucose and sodium bicarbonate were administered via intravenous drip to accelerate intracellular transportation of K~ and diuretics were used to promote the excretion of K~. Hemodialysis therapy was used if the treatment is ineffective. The serum level of potassium restored to normal range after treatment in all cases. For those presenting with critical values of other parameters, individualized treatment was adopted based upon different conditions. Understanding of common critical values during perioperative period, characteristics and causes of distribution of critical values in renal transplant recipients of different age and gender offers guidance for clinical monitoring and treatment.