300例肾移植术患者围手术期护理体会

2000年2月-2006年12月，我们共完成同种异体。肾移植术300例，其中男212例，女88例；年龄8—75岁。术后平均住院4周，1a存活率为99％，3—5a存活率为85％。现将护理体会报告如下。     

老年喉癌患者的围手术期护理

1998年12月～2002年11月，我院收治老年喉癌患者62例，现将围手术期护理体会报告如下。     

老年妇科疾病患者50例围手术期处理

2005年1月～2006年9月，我院共为50例老年患者施行妇科手术，现将围手术期处理报告如下。     

高龄肾移植患者围手术期护理

肾移植是治疗各种终末期肾病的最佳手段.但以前认为高龄尿毒症患者(超过60岁)手术风险大,感染和心脑血管并发症多,不适于肾移植治疗.     

胸外科老年肿瘤患者围手术期医院感染的临床分析

胸外科老年肿瘤患者围手术期医院感染是一个应引起重视的问题,为降低其发生率,作者回顾性调查了2000年1月至2004年12月期间同济医院胸外科587例在60岁以上的老年肿瘤手术患者的医院感染情况,报告如下.     

老年肺癌患者围手术期处理体会

老年肺癌患者由于脏器的生理功能低下，合并疾病较多，进行手术治疗潜在的危险性较其他年龄段明显增大。因此做好围手术期的处理尤为重要。     

老年糖尿病足坏疽截肢患者围手术期护理

糖尿病足坏疽(DIGF)是糖尿病晚期血管闭塞的一种严重并发症,发病率已达到糖尿病的49·5%,大面积坏疽和严重感染时常有致命危险,截肢是挽救患者生命的重要措施[1]。老年糖尿病患者常合并心、肺、脑、肾等基础疾病,对手术的耐受性差,增加手术困难和危险性,为提高手术成功率,我科自2000年1月~2005年12月,对25例老年DIGF行截肢手术患者重视围手术期护理,取得满意效果,现报告如下。本组25例,男18例,女7例,年龄60~80岁,平均糖尿病史13年,25例中合并高血压12例,慢性支气管炎5例,冠心病8例。小腿截肢16例,膝关节以上截肢9例。治疗的成功与护理有…     

老年消化系恶性肿瘤患者围手术期治疗(附102例分析)

笔者回顾性分析解放军第305医院102例老年消化系肿瘤手术患者资料，以探讨围手术期处理的方法，总结经验教训。[第一段]     

老年大肠癌患者的围手术期治疗体会

大肠癌是消化道常见的恶性肿瘤之一，随着我国人民生活水平的提高，饮食结构的改变，平均寿命的延长，老年大肠癌患者的发病牢也逐渐增加。为研究老年大肠癌患者临床特点及围手术期处理特点，以达到“根治肿瘤，改善生活”的最终目的，现归纳分析北京海军总医院于2002年10月～2008年8月收治70岁及以上的老年大肠癌患者123例，总结报告如下。     

老年患者肾移植的临床经验

目的　探讨高龄患者肾移植手术的适应证、免疫抑制剂的应用和对急性排斥的免疫监测及其他并发症的防治。方法　对 64例 60～71岁尿毒症患者进行尸体肾移植手术 ,术后进行移植肾脏功能、T细胞亚群、ICAM 1等指标监测。结果　 1年人 /肾存活率为 92 .6 % / 83 .9% ,3年为 85 .2 % / 74.1 % ,5年为 82 .4% / 72 .2 %。急性排斥发生率为 2 7%。结论　合理应用免疫抑制剂及监测和治疗急性排斥反应 ,降低术后并发症是提高老年患者肾移植存活率的重要因素     

Treatment of anemia with epoetin in kidney transplant recipients

The aim of this study was to analyze the prevalence and efficacy of renal anemia treated with epoetin in maintenance kidney transplant recipients in Slovenia. By the end of 2009, 107 out of 537 patients (19.9%) had been treated with epoetin. A cohort of 49 patients (45.8%) were analyzed in detail: 11 patients received epoetin alpha, 18 epoetin beta, 10 darbepoetin alpha, and 10 patients received methoxy polyethylene glycol-epoetin beta. The median epoetin dose was 0.36 μg/kg body weight per week. The median serum laboratory parameters were as follows: hemoglobin 120 g/L, hematocrit 0.36, ferritin 332 ng/mL, transferrin saturation 34%, serum creatinine 145 μmol/L, serum albumin 41 g/L, intact parathyroid hormone 79 ng/L, and C-reactive protein 3 mg/L. We concluded that the prevalence of renal anemia in kidney transplant recipients treated with epoetin was approximately 20%, and laboratory parameters suggested that the treatment of renal anemia in this study cohort was optimal.     

Evolution of hepatitis B management in kidney transplantation

Chronic hepatitis B virus(HBV)infection adversely influences the clinical outcomes of renal transplant recipients owing to increased hepatic complications.Management of HBV infection in kidney transplant recipients presents a challenge to clinicians,especially in endemic regions.Interferon precipitates renal allograft dysfunction.Treatment with lamivudine,the first oral nucleoside analogue available,resulted in effective viral suppression,reduced liver-related complications,and improved patient survival so that medium-term data showed comparable patient survival rates between hepatitis B surface antigen-positive and HBsAg-negative kidney transplant recipients in the era of effective antiviral therapies.Entecavir has replaced lamivudine as first-line therapy for treatment-na?ve subjects in view of the propensity for drug resistance with the latter.Management of HBV infection in kidney transplant patients needs to take into consideration the nephrotoxicity of nucleoside/tide analogues such as adefovir and tenofovir.Prevention of HBV-related complications in kidney transplant recipients starts much earlier prior to transplantation,with vaccination of patients with chronic kidney disease and donor-recipient matching with regard to HBV status.In addition to anti-viral treatment,patients with chronic HBV infection must have regular surveillance for liver cancer and assessment for the development of cirrhosis.     

肾移植术后并发卡氏肺孢子虫肺炎

目的 提高对肾移植术后并发卡氏肺孢子虫肺炎(pneumocystis caeinii pneumonia,PCP)的认识和救治水平.方法 综合分析我院11例肾移植术后并发PCP患者的临床资料.结果 11例PCP患者发病于术后2～6个月,7例经支气管镜肺泡穿刺和支气管肺泡灌洗确诊,4例经诊断性治疗确诊.应用复方磺胺甲基异嗯唑(CoSMZ),辅以糖皮质激素治疗,以及调整免疫抑制剂.9例早期确诊者康复出院,2例病程超过1个月以上的患者,因广泛肺实变和纤维化,死于呼吸衰竭.结论 肾移植术后PCP发生率较高,早期诊断和及时治疗是改善预后的关键,支气管肺泡灌洗确诊率较高,必要时早期应用CoSMZ进行诊断性治疗,不失为有效方法.     

老年亲属供肾肾移植临床效果分析

目的 了解老年人供肾亲属肾移植临床效果. 方法 回顾性分析我院肾移植科2005年11月至2011年6月亲属活体肾移植的临床资料,按供者情况分为老年亲属供肾组36例(老年组),非老年亲属供肾组208例(非老年组).比较两组受者术后3d、7d、1个月、3个月、6个月、12个月、24个月、36个月血肌酐(SCr)水平和外科并发症、急性排斥、钙调磷酸酶抑制剂(CNI)肾毒性、移植肾功能延迟(DGF)发生率,并观察1年、3年人和(或)肾存活率. 结果 老年组受者SCr术后3d为(245.2±135.2)μmol/L、7d为(150.5±86.8)μmol/L、1个月为(140.6±42.5)μmol/L,高于非老年组的(185.6±148.4)μmol/L、(122.2±136.8)μmol/L、(117.8±33.2)μmol/L(分别为t=84.07、31.90、21.54,均P=0.000);CNI肾毒性发生率分别为22.2％(8/36)、1.9％(4/208),差异有统计学意义(x2=27.04,P=0.000);但两组受者术后3个月、6个月、12个月、24个月、36个月SCr水平和外科并发症、急性排斥、DGF发生率及1年、3年人和(或)肾存活率比较,差异无统计学意义(均P＞0.05). 结论 术前对老年供者进行严格筛选和综合评估,健康老年人亲属供者不应作为供者禁忌;但对老年人供肾亲属肾移植受者应注意CNI肾毒性.     

Dialysis patients refusing kidney transplantation: data from the Slovenian Renal Replacement Therapy Registry

Kidney transplantation is considered the best renal replacement therapy (RRT) for patients with end-stage renal disease; nevertheless, some dialysis patients refuse to be transplanted. The aim of our registry-based, cross-sectional study was to compare kidney transplant candidates to dialysis patients refusing transplantation. Data were collected from the Slovenian Renal Replacement Therapy Registry database, as of 31 December 2008. Demographic and some RRT data were compared between the groups. There were 1448 dialysis patients, of whom 1343 were treated by hemodialysis and 105 by peritoneal dialysis (PD); 132 (9%) were on the waiting list for transplantation, 208 (14%) were preparing for enrollment (altogether 340 [23%] dialysis patients were kidney transplant candidates); 200 (13.7%) patients were reported to refuse transplantation, all ≤ 65 years of age; 345 (24%) were not enrolled due to medical contraindications, 482 (33%) due to age, and 82 (6%) due to other or unknown reasons. No significant difference was found in age, gender, or presence of diabetes between kidney transplant candidates vs. patients refusing transplantation (mean age 50.5 ± 13.9 vs. 51.3 ± 9.6 years, males 61% vs. 63%, diabetics 18% vs. 17%). The proportion of patients ≤ 65 years old who were refusing transplantation was 28% (187/661) for hemodialysis and 17% (13/79) for PD patients (P = 0.03). There is a considerable group of dialysis patients in Slovenia refusing kidney transplantation. Compared to the kidney transplant candidates, they are similar in age, gender and prevalence of diabetes. Patients treated by peritoneal dialysis refuse kidney transplantation less often than hemodialysis patients.     

1 118例肾脏移植临床总结

目的 :回顾总结肾脏移植经验、改善临床肾脏移植效果。　 方法 :总结 1992年 7月～ 2 0 0 0年 10月1118例肾脏移植的临床资料 ,研究组织配型、器官摘取情况、移植手术、移植并发症、免疫抑制剂等因素对移植效果的影响。　 结果 :存活率 :术后 1、3、5年人 /肾存活率分别为 93%/ 91 2 %、80 2 %/ 74 5 %、72 %/ 6 6 1%。超急排斥反应发生率 1 2 %,急性排斥反应发生率 2 3 5 %,慢性排斥反应发生率 16 7%。并发症发生率 5 5 %。死亡率16 6 %。　 结论 :①加强供受者组织配型、提高器官摘取以及移植手术质量可以明显提高移植物的存活 ,减少外科并发症的发生 ;②并发症是影响人 /肾长期存活的重要因素 ;③合理应用免疫抑制剂可以延长移植肾的存活 ,减少并发症的发生。     

Long-term outcomes after organ transplantation in diabetic end-stage renal disease

Patients with type 1 diabetic end-stage renal disease (ESRD) may be offered single kidney transplantation from a live donor (LDK) or a deceased donor (DDK) to replace the lost kidney function. In the latter setting the patient may also receive a simultaneous pancreas together with a kidney from the same donor (SPK). Also in some cases a pancreas after kidney may be offered to those who have previously received a kidney alone (PAK). The obvious benefit of a successful SPK transplantation is that the patients not only recover from uremia but also obtain normal blood glucose control without use of insulin or other hypoglycemic agents. Accordingly, this combined procedure has become an established treatment for type 1 diabetic patients with ESRD. Adequate long-term blood glucose control may theoretically lead to reduced progression or even reversal of microvascular complications. Another potential beneficial effect may be improvement of patient and kidney graft survival. Development of diabetic complications usually takes a decade to develop and accordingly any potential benefits of a pancreas transplant will not easily be disclosed during the first decade after transplantation. The purpose of the review is to assess the present literature of outcomes after kidney transplantation in patients with diabetic ESRD, with our without a concomitant pancreas transplantation. The points of interest given in this review are microvascular complications, graft outcomes, cardiovascular outcomes and mortality.     

急诊肝移植围手术期凝血功能的调整

回顾分析7例急诊肝移植患者围手术期凝血功能的调整方法，旨在提高急诊肝移植围手术期的管理水平，现报道如下。