肾移植围手术期补液监控

背景：多尿期肾移植患者围手术期的水及糖电解质的平衡与及时的营养支持治疗对移植肾脏的功能恢复至关重要。 目的：探讨。肾移植围手术期的水电解质平衡维护及营养支持的方法和时机。 设计、时间及地点：回顾性临床分析，于2003-06／2007-06在解放军第四军医大学西京医院泌尿外科完成。 对象：接受同种异体。肾移植的慢性肾功能衰竭患者96例，男59例，女37例，年龄17～67岁，平均35．7岁。 方法：以移植肾动、静脉血流开放时间为分界点，总结患者围手术期的生理特点。术前维持患者生命体征平稳，手术开始时即开始匀速输血，移植动、静脉血管开放前积极补充清蛋白，开始排尿且尿量大于每小时100mL，即开始循环补循环补液配方，简化的肾移植术后多尿期输液。 主要观察指标：术后1d检测患者血肌酐、尿素氮、电解质、血糖和尿液。 结果：术后最初12～16h。患者尿量在260～1200mldh，平均520mL／h。术后测血常规显示，8例出现轻度低钠血症，占8.3％。3例出现高钾，于肾功能恢复后正常，1例发生低钾，补钾治疗及肾功能恢复后正常。血氯无异常变化。21例血糖高于正常，占21．9％，激素冲击结束后恢复正常。其他患者电解质、血糖均正常，无低钙、镁者。尿比重均在1．010～1．015之间。 结论：移植。肾动、静脉血流开放前的输液应以胶体如浓缩红细胞、血浆及清蛋白为主，多尿期应规律及时的补充水及电解质，适当的营养支持有助于吻合口愈合，尿量稳定后应预防代谢性酸中毒。

Fluid replacement monitoring during perioperative period of renal transplantation

BACKGROUND: The nutritional support, as well as the water and electrolyte balance during the perioperative period in the renal transplantation recipients at diuresis stage are important to the functional restoration of transplanted kidneys.OBJECTIVE: To explore the method and opportunity of the nutritional support and the handling of the water and electrolyte balance in perioperative period of renal transplantation.DESIGN, TIME AND SETTING: A retrospective clinical analysis was performed in the Department of Urology, Xijing Hospital from June 2003 to June 2007.PARTICIPANTS: Ninety-six patients of chronic renal failure underwent allograft renal transplantation. They comprised 59 males and 37 females, aged 17-67 years, with a mean of 35.7 years.METHODS: The perioperative physiological features of the renal transplantation recipients were summarized retrospectively. The recipients' condition during the perioperative period was divided into two stages at the opening point of allograft blood current. The vital signs of the patients maintained at a stable level before operation. All patients received blood transfusion since the operation began, and were supplemented with albumin before opening the vessels. Urinary production exceeding 100 mL per hour indicated the beginning of fluid replacement, which was a simplified transfusion for the patients at diuresis stage following renal transplantation.MAIN OUTCOME MEASURES: Blood inosine, urea nitrogen, electrolyte, blood sugar and urine of the patients were detected at one day postoperatively.RESULTS: During 12-16 hours postoperatively, the urinary production was 260-1 200 mL, average 520 mL per hour. Blood routine test showed 8 cases developed mild hyponatremia, accounting for 8.3%, 3 cases occurred high potassium and healed after renal functional recovery, 1 case presented low potassium and healed with supplement therapy. There were no abnormal changes of blood chlorine. The blood glucose among 21 cases (21.9%) was higher than the normal level, and recovered following hormone maneuver. The electrolytes and blood glucose were detected to be normal in other patients, without any case with low calcium or magnesium. The urine specific gravity arranged during 1.010-1.015.CONCLUSION: The colloid such as erythrocytes, blood plasma and albumin should be mainly infused before the opening of allograft blood current. And the water and electrolytes is recommended to administrate promptly and regularly during the diuresis stage. The healing of the stoma benefits from the adequate nutritional support. The metabolic acidosis still should be prevented when the urinary production returns normal.