山莨菪碱防治甘油所致急性肾功能衰竭的实验研究

在１２９只ＳＤ大鼠的实验中动态观察了山莨菪碱对甘油所致急性肾功能衰竭时不同时期的Ｂｃｒ，ＢＵＮ，ｐＨ病理改变及死亡率的影响，结果表明：山莨菪碱能降低ＡＲＦ第５天大鼠死亡率以及Ｂｃｒ，ＢＵＮ水平。改善病理损害，对ＡＲＦ起到预防及治疗效果，山莨菪碱的预防效果优于治疗效果，预防是ＡＲＦ防治的关键，但山莨菪碱在治疗过程中要引起“冲刷综合征”导致洗脱性酸中毒，应引起注意。     

活体亲属供肾肾移植的临床分析

目的　总结分析活体亲属供肾肾移植的手术和治疗经验 ,探讨其临床效果 .方法　回顾性分析 33例活体亲属供肾肾移植的临床资料 ,包括手术方法和创新、免疫抑制药物的用药方案及临床效果 .结果　本组全部切取左肾 ,经腹手术 ,手术顺利 ,移植肾在开放血液循环后 1～ 10分钟内分泌尿液 .供体肾功能在 1周内恢复正常 ,未出现严重并发症 .受者仅 2例出现急性排斥反应 .全部受者至今存活 ,肾功能良好 .结论　活体亲属供肾 ,移植效果明显优于尸体供肾肾移植 .排斥反应发生率低 ,恢复顺利     

肾移植术后带状疱疹治疗的临床研究

目的 探讨中西医结合治疗肾移植术后带状疱疹有效的方法.方法 中西医结合治疗组14例：口服阿昔洛韦0.4g,5次/d,强的松片15mg早晨顿服,加服中药龙胆泻肝汤加减.对照组13例：口服阿昔洛韦0.4g,5次/d,强的松片15mg早晨顿服.结果 中西医结合治疗组14例中中痊愈13例,痊愈率92.85%,临床有效率100%.对照组13例中痊愈10例,痊愈率76.92%,临床有效率84%.结论 中西医结合治疗方法可缩短疗程,治愈率高,减少后遗症神经痛的发生率.     

益寿饮颗粒对衰老动物模型免疫功能的影响

目的探讨益寿饮颗粒剂对衰老动物模型免疫功能的影响。方法模型大、小鼠各60只，按20只分组，分为生理盐水对照组、益寿饮小剂量组和益寿饮大剂量组。各组连续灌胃30d，停药后小鼠摘取眼球取肝素抗凝静脉血，大鼠自尾静脉取血，测IL-1α，IL-2，IL-6，RBC—C3bRR，RBC-ICR以及外周血T淋巴细胞亚群。结果大、小剂量组与对照组比较，IL-1α，IL-2，IL-6水平明显升高，RBC—C3bRR结合率明显升高，RBC—ICR结合率明显下降，CD3^＋，CD4^＋淋巴细胞的比值明显升高，CD8^＋淋巴细胞的比值明显降低，各项指标均具有统计学意义。结论益寿饮颗粒提高衰老动物模型T淋巴细胞增殖和产生白介素-1（IL—1）、白介素-2（IL-2）、白介素-6（IL-6）的能力，增强红细胞膜RBC—C3bRR活性及粘附IC的能力，影响外周血T淋巴细胞亚群分类的水平，影响外周血T淋巴细胞亚群的数量、活性及亚群细胞之间的比例，调节T细胞的免疫功能，改善机体免疫调节功能。     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

老年活体亲属供肾移植的安全性分析

目的 探讨老年活体亲属供肾移植供体、受体的围手术期并发症、疗效及安全性.方法 亲属活体供肾移植132例,分为老年供体组(≥55岁,43例)和中青年供体组(＜55岁,89例);对供受体的住院时间、手术前后血肌酐(SCr)、内生肌酐清除率(CCr)、肾小球滤过率(GFR)、并发症以及受体的急性排斥反应率、人/肾存活率等进行比较分析.结果 2组供者术前SCr分别为(77.67±15.21)、(83.09±15.98)μmol/L,术后7 d分别为(109.54±22.32)、(106.56±23.46)μmol/L,均在正常范围内,2组间各时间点比较差异均无统计学意义(P值均＞0.05).术后3个月2组供者SCr分别为(112.57±20.87)、(104.29±19.43)μmol/L,与术前比较分别上升44.93%和25.51%,老年供体组比中青年供体组供者scr升高更明显.差异有统计学意义(P=0.0268).2组术前CCr分别为(1.63±0.34)、(1.56±0.25)ml/s,术后10 d分别为(0.83±0.29)、(1.11±0.27)ml/s.老年供体组术后3个月CCr为(0.97±0.10)ml/s,中青年供体组为(1.16±0.17)ml/s.2组手术前后CCr变化差异无统计学意义(P＞0.05).老年供体组术后10 d的留存肾GFR为(36.58±13.26)ml/min,术后3个月增加至(52.31±12.74)ml/min,达到原双肾GFR[(73.01±20.96)ml/min]的71.65%.中青年供体组术后10 d GFR为(38.32±10.79)ml/min,术后3个月增至(56.31±12.95)m1/min,达到原双肾GFR[(78.34±20.98)ml/min]的71.88%.手术前后GFR变化差异均无统计学意义,P值均＞0.05.供者手术并发症包括术中脾脏包膜下血肿1例、降结肠破裂1例和切口脂肪液化5例.术前和术后各时间点2组受者SCr水平差异无统计学意义(P值均＞0.05).2组供者平均住院时间分别为(13.2±3.4)和(12.8±2.6)d,P=0.4563.2组受者平均住院时间分别为(23.1±11.9)和(22.3士11.4)d,P=0.6991.老年供体组受者6个月内急性排斥反应发生率为4.7%(2/43),中青年供体组为7.9%(7/89).术后1年内2组各死亡1例,中青年供体组因急性排斥反应移植肾失功1例.结论 老年活体亲属供肾可能存在一定危险性,应予以重视,但供体年龄并非独立风险因素.在严格控制老年供者的纳入标准、对供者进行全面系统评估的情况下,老年供体活体肾移植的供体和受体围手术期并发症/疗效及安全性与中青年供体比较无明显差异.     

移植肾动脉狭窄的诊断和治疗探讨

目 的 探讨移植肾动脉狭窄(TRAS)的临床特点及诊治方法。方 法 回顾我院1999年3月至2009年8月共1084例肾移植患者的临床资料,对移植肾动脉狭窄患者的发病特点及诊治方法进行总结分析。结 果 共1084例肾移植患者,尸体肾移植876例,活体肾移植208例,发生移植肾动脉狭窄共6例,总发生率为0.55%,其中5例发生于尸体肾移植,其发生率为0.57%;1例发生于活体肾移植,其发生率为0.48%。其中5例为供肾动脉与受者髂外动脉行端侧吻合,其发生率为0.57%（5/872）,另1例为供肾动脉与受者髂内动脉行端端吻合,其发生率为0.47%（1/212）。狭窄发生部位：动脉吻合口狭窄4例,移植肾上段动脉1例,肾动脉主干1例。6例患者表现为血压突然升高、常规降压药物疗效欠满意、尿量明显减少、血肌酐进行性升高,均先经彩色多普勒血流显像（CDFI）进行筛查,移植肾主动脉主干或吻合口处峰值流速（Vp）≥300cm/s,其中5例再经CT血管造影（CTA)做出初步诊断,最后通过数字减影血管造影(DSA)确诊,且提示狭窄程度为70%-95%,另1例直接用DSA确诊。5例患者确诊后均通过经皮腔内肾动脉支架置入术（PTRAS）治愈,1例患者先经皮腔内血管成形术(PTA),3个月后再次发生原部位狭窄行PTRAS治愈。6名患者已分别随访0.5、3、6、12、18、40个月,未再出现狭窄,移植肾功能功能良好,血肌酐平均小于140umol/L。结 论 （1）血压及血肌酐升高、尿量减少为TRAS的主要临床表现;（2）CDFI为TRAS的首选筛查手段,CTA和DSA为TRAS可靠的确诊方法,而且可以对血管狭窄部位及程度做出判断;（3）PTA和PTRAS为治疗TRAS的重要方法。     

亲属活体肾移植19例报告

目的总结分析活体亲属供肾移植的围手术期的管理、手术和治疗经验,探讨其临床效果。方法回顾性分析19例亲属活体供肾移植的临床资料,包括术前检查、手术方法和创新、免疫抑制的用药方案及临床观察。结果供肾均为左肾,经腹手术,手术顺利,移植肾在开放血液循环后1～10min内分泌尿液,供体肾功能在1周内恢复正常,未出现严重并发症,全部受者存活至今,肾功能良好。结论亲属活体供肾移植的移植效果明显优于尸体供肾移植,排斥反应发生率低,恢复顺利。