高龄肾移植患者的心血管问题

目的：总结高龄肾移植患者的心血管问题及其处理经验，提高肾移植的存活率。方法：对96例高龄肾移植患者的心血管问题进行回顾性分析、结果：术前检查发现冠心病6例，4例经冠状动脉造影证实，3例行冠状动脉搭桥术，6例病人均顺利度过手术关，木后人、肾存活；术前慢性低血压4例，予碳酸氢盐透析、白蛋白、麻黄素或精氨酸加压素等处理，术中、术后用白蛋白、升压药维持血压，1例因血压不能维持而切肾，另3例人、肾存活好；术后心力裹竭10例，经血液透析超滤脱水、强心、利尿等处理，2例死亡，余存活好；术前高度房室传导阻滞1例，安装起搏器后行肾移植术，过程顺利，人、肾存活5年余。术后频发室性早搏2例，1例用药物按制，1例因合并心力衰竭而死亡。结论：对疑为冠心病的高龄肾移植受者应尽可能行冠状动脉造影术，对多支血管严重狭窄（大于70％）或冠状动脉主干病变应行外科纠正。术前慢性低血压经积极处理后可行肾移植术。水后心力衰竭多由容量过多引起，血液透析超滤脱水十分重要。高度房室传导阻滞安装起搏器后不是肾移植手术的禁忌。

The Cardiovascular Problem in Elder Renal Allograft Recipients

To sum up the cedovascular problem and the management experience in elder renal allograft recipients. Methods: The cardiovascular problem in 96 cases of elder renal allograft recipients wer reviewed.Results:Six cases of coronary t=heart disease(CHD) were found before opration, four were identified by coronary arteriography ,coronary bypass operation was done in thre of them. Successful opetraion was done in all six patients,and all patients/allografts survived well. pre-operation examinations found four chronic hypotension patients , bicarbonate chalysis ,albumin,ephedrine and argipressin were given before operation, albumin and drugs were given to maintain the blood pressure during and after operation. One patient we done allograft removal because of persistent hypotension, the others survived well. Posttransplantation heart failure was found in 10 patients, after hemodialysis ultrafiltration, positively inotropic agents and diuretics treatmetn,2were died,the others survived well.A high degree of atrioventricular block (AVB) patient with artificial pacemaker was found before operation,the operation successful, the patient was are survival well for more than five years.Two eases of frequent Ventriclarpremature beats were found after operation , one conrolled by drugs, one died. because of heart failare. Conclusion: Coronary arteriograpgy should be done if possible to comfirm the suspicious CHD patients. If significant multivessel or main coronary vessel stenosis(> 70% ) was found surngical correction should be recommended.Pretrantehohanahon chmnic hypoendon, if controlled actively, was not a Contradiction of f renal engraft.Posttransplantaiton heat failure was caused by volume oveload,hemodialysis ultrafiltraiton was a critical treatment. High degree of AVB patient with pacemaker was not a contradiction of renal transplatation.