婴幼儿死亡后器官捐献单侧供肾用于成人肾移植术后的护理

Nursing of adult patients undergoing renal transplantation from infant kidney donation after death

目的探讨婴幼儿死亡后器官捐献(donation after death,DCD)单侧供肾用于成人移植术后的临床特点,总结术后护理要点。方法 2014年1月至2016年6月对36例婴幼儿用于DCD单侧供肾成人受者进行肾移植手术,术后根据患者早期临床特点,给予针对性护理对策。结果 36例婴幼儿DCD单侧供肾用于成人肾移植术后发生肺部感染3例,切口感染2例,移植肾血栓2例,移植肾输尿管尿瘘2例,移植肾功能延迟恢复(delayed graft function,DGF)16例。术后随访1~20个月,36例受者均成活,其中34例受者移植肾功能恢复良好,2例因移植肾动静脉血栓形成而切除移植肾。结论婴幼儿DCD单侧供肾用于成人肾移植手术难度大,术后并发症多,护理难度大。在护理方面应加强术中、术后患者血压的监控,严格控制出入量的管理,做好早期并发症的观察及护理,其对提高移植肾的存活率,减少并发症发生,促进患者早期康复具有重要意义。

Objective To analyze the clinical characteristics of single renal transplantation from infant kidney donation after death （DCD） and summarize the nursing measures for nursing the infants. Method The clinical data of 36 cases of single kidney transplantation from 18 infant donors from January 2014 to June 2016 in our centre were reviewed and summarize the nursing experience. Results Pulmonary infection occurred in 3 cases, incision infection occurred in 2 cases and graft vascular complication occurred in 2 cases. Urinary fistula occurred in 2 cases, ureteral obstruction occurred in 1 case, delayed graft function （DGF） occurred in 16. Postoperative follow-ups for 1 to 20 months showed all the grafted kidneys survived and 34 of them were well recovery in view of renal function of grafted kidney and the rest two had the grafted kidneys resected because of arterial and venous thrombus in them. Conclusions The renal transplantation from infant DCD is difficult. The nurses should handle postoperative care to the patients, paying attention to the complications. On the other hand, intra-and post-operative monitoring of blood pressure, control of input and output and early observation of complications and treatment is of value for the improvement of survival rate of grafted kidneys, reduction of complication incidence and propelled recovery of the patients.