老年患者肾移植临床分析

Clinical analysis of kidney transplantation in the elderly patients

目的 探讨 6 0岁以上老年患者肾移植的临床特点。方法 回顾性分析超过 6 0岁的81例肾移植患者的临床资料 ,并以同期小于 6 0岁的肾移植患者 432例作对照。结果 老年患者透析时间长 ,低蛋白血症严重 ,冠心病、糖尿病及心脏衰竭发病率高 ,与对照组比较 ,差异有显著性 (P <0 .0 5 ) ;老年组人 /肾 1、3年存活率分别为 90 .1% / 88.0 %、80 .6 % / 75 .0 % ,对照组分别为 93.7% /92 .6、81.1% / 76 .4% ,两组比较 ,差异无显著性 (P >0 .0 5 )。老年组术后肺部感染、肝功能损害、心脏衰竭、心绞痛及糖尿病等的发生率均高于对照组 (P <0 .0 5 )。结论 老年患者进行肾移植时 ,心血管并发症和感染是引起死亡的主要原因。术前应慎重选择、充分准备、严格配型 ,术后合理使用免疫抑制剂、积极处理并发症。

Objective To investigate the features of kidney transplantation in patients over 60 years old.Methods From May 1998 to Oct. 2001,the clinical data of 81 cases over 60 post kidney transplantation were retrospectively analysed and compared with those of 432 patients below 60 age. Results The dialysis time of senile group was longer and the hypoproteinemia was sever than that of control group (P< 0.05) and also the incidences of coronary heart disease, diabetes and heart failure were higher (P< 0.05). The patient/graft survival rates of senile group at 1, 3 years were 90.1?%/ 88.0?%, 80.6?%/ 75.0?% respectively with no significant difference from the control group (P> 0.05). The postoperative incidence of pulmonary infection was higher(P< 0.05) and so were the hepatic dysfunction, angina, heart failure and diabetes. The cardiovascular accident and pulmonary infection were the main causes of mortality.Conclusion Satisfactory effects could be obtained in senile patients after renal transplantation if cautious selection, rational preparation and strict match were conducted before operation and reasonable use of immunosuppressive agents and actively preventing and treating complications were performed after operation.