肾移植术后早期氧自由基的变化

我们通过监测２０例肾移植病人术前，术后早期血ＳＯＤ、ＬＰＯ、ＧＳＨ－ＰＸ的变化，研究移植术后早期自由基对肾功能的影响。结果显示移植肾恢复血液灌流１小时，ＳＯＤ变化较ＬＰＯ、ＧＳＨ－ＰＸ敏感；与术前比较，ＳＯＤ明显下降，移植肾恢复正常功能时间明显延长，ＳＯＤ成倍下降时，预示移植肾不可逆性损伤；低流量，低Ｏ２灌注是否影响自由基的生成，仍需进一步探讨。     

肾移植术后早期急性心力衰竭的抢救与治疗八例

2000年1月至2005年10月我院共行肾移植术214例，其中术后1周内发生急性心力衰竭8例，经对症治疗后6例好转，2例死亡。报道如下：     

肾移植术后伪膜性肠炎六例报告

肾移植术后腹泻是较为常见的并发症，明确病因是伪膜性肠炎的报告不多。2000年1月至2004年11月在我院的362例肾移植患者中，有6例发生伪膜性肠炎，现报告如下。     

肾移植术后巨细胞病毒病的治疗

巨细胞病毒(ＣＭＶ)病是肾移植术后常见而严重的感染并发症,临床治疗效果差,死亡率高。如何准确地诊断,有效地治疗是临床医师急需解决的难题。本文对近年肾移植术后发生的ＣＭＶ病42例的治疗进行分析总结,报道如下。一、临床资料1992年12月～1998年1月治疗ＣＭＶ病42例。男32例,女10例。年龄19～64岁,平均42.5岁。发病时间术后2周～10个月。42例中2例为再次肾移植,40例为首次肾移植。术后用环孢素Ａ(ＣｓＡ),硫唑嘌呤(Ａｚａ)和泼尼松(Ｐｒｅｄ)三联免疫抑制治疗。具体方法是:术中静脉用甲泼尼龙(ＭＰ)1.0ｇ或抗胸腺淋巴细胞球蛋白(ＡＴＧ)3…     

紫外线照射治疗肾移植术后口腔溃疡16例

我院于2000年以来对16例肾移植后发生口腔溃疡的患者采用紫外线照射，同时配合局部用药及心理指导进行康复治疗，取得了满意疗效，现报告如下。     

肾移植术后早期血中Cystatin C的变化

选择 2 0 0 1年 1月至 1 2月在我院接受同种异体肾移植、术后无排斥反应的患者 30例 ,其中男性 1 9例 ,女性 1 1例 ,年龄 2 4～ 68岁 ,平均 43 .8岁。乳胶增强的ＣｙｓｔａｔｉｎＣ以多克隆免疫抗体为基础的改良免疫抗体分析法测定。取患者的血清或加肝素的血浆 3ｍｌ,检测仪器为美国德灵公司ＢＮ 1 0 0全自动特定蛋白分析仪 ,试剂盒为西司他汀。ＣｙｓｔａｔｉｎＣ正常值为 0～0 .96ｍｇ/Ｌ。血肌酐、尿素氮由贝克曼全自动生化分析仪测定 ,其正常值分别为≤ 1 33μｍｏｌ/Ｌ、≤ 7.1 4ｍｍｏｌ/Ｌ ,肌酐清除率根据血肌酐采用Ｃｏｃｋｃｒｏ…     

肾移植受者术后早期尿路感染病原菌及耐药性分析

肾移植患者是接受免疫抑制治疗的特殊人群，术后早期尿路感染的病原菌谱可能与普通尿路感染患者有所不同。为了避免临床滥用抗生素造成病原菌种类变迁加速和诱导耐药菌产生，本研究总结我院肾移植患者术后早期双J管移植肾肾盂端和膀胱端培养的细菌及其耐药情况，从而指导临床合理应用抗生素。     

肾移植术后巨细胞病毒感染

巨细胞病毒(ＣＭＶ)感染是肾移植术后的一种常见并发症,据报道ＣＭＶ活动性感染率在肾移植受者中约50%～75%,有10%～30%的患者为有症状的ＣＭＶ感染。供者血清学ＣＭＶＩｇＧ阳性,受者阴性,是ＣＭＶ感染的高危人群,术后感染率高达96%。轻度感染者一般为自限性疾病,症状多数在1～3周内自行消失。一旦发生严重的ＣＭＶ感染,特别是肺间质性炎症,死亡率高达25%。一、ＣＭＶ和ＣＭＶ感染ＣＭＶ是人类疱诊病毒之一。它有复杂的双链ＤＮＡ螺旋核心,因病毒侵入细胞内,外面包裹有宿主胞核膜,或内质网形成的脂质层包壳,直径约180ｎｍ。病毒基因包含重…     

肾移植术后带状疱疹的诊断与治疗

免疫抑制剂的使用或免疫抑制过度是器官移植术后病毒感染的最重要原因。３０１例肾移植患者术后３１例发生带状疱疹，发病率为１０．３％，发病时间以术后１～２年间最多见，多伴有细胞免疫功能下降。治疗包括抗病毒药物应用、调整免疫抑制剂方案、防止合并细菌感染和对症处理等四个方面。认为阿昔洛韦抗病毒效果较好，而适当减少免疫抑制剂的用量则是治疗的关键     

肾移植术后并发巨细胞病毒性肺炎的护理

肾移植术后并发巨细胞病毒 (cytomegalovirus,CMV)感染 ,特别是巨细胞病毒性肺炎 (cytomegalovirus pneumonitis,CMVP) ,可因呼吸衰竭导致死亡。我科 2 0 0 0年 5月至 2 0 0 1年 1月共收治肾移植术后 CMVP病人 1 2例 ,报告如下。1　临床资料1 .1　一般资料1 2例中 ,男 9例、女 3例 ,年龄 2 6～ 5 8岁 ,平均3 7.0岁。均因慢性肾衰竭而行同种异体肾移植术 ,术后 2～ 6个月发病入院。入院时均有不同程度的胸闷、呼吸困难、顽固性低氧血症、咳嗽、咳痰或干咳。其中 9例病情危重 ,高热 (体温 9～ 40℃ ) ,呼吸极度困难 ,动脉血氧分压 (Pa O…     

肾移植术后病人生活质量及影响因素的调查研究

目的 探讨肾移植术后病人的生活质量及影响因素，为有的放失地改进、完善护理措施提供依据。方法 采用问卷调查法，同时对112例肾移植术后病人及112例健康人群进行生活质量调查。结果 病人的生活质量低于健康人群，差异有极显著性意义(P＜0．01)。影响病人生活质量的因素有：肾移植术后时间，术后是否有排异反应，对肾移植知识的了解程度。结论 护理人员应采取针对性的身心护理措施，重点加强健康指导和相关知识教育，提高肾移植术后病人的生活质量。     

肾移植病人家庭护理干预效果分析

目的：了解家庭护理干预对社区肾移植病人生活质量的影响。方法：将200例出院后肾移植病人随机分为两组，干预组（100例）进行生理，心理，社会行为等护理干预，对照组（100例）未实施干预，运用日常生活能力量表（ADL），社会功能评定量表（SDSS），抑郁自评量表（SDS）及护理依赖性评估干预前后的效果进行分析，比较；同时比较两组并发症发生情况。结果：干预组病人的心理功能，社会功能及日常生活能力较干预前显著改善，差异有极显著性意义（均P＜0．01），两组并发症发生率比较，差异有极显著性意义（P＜0．01），结论：家庭护理干预可提高肾移植病人的生活质量，减少术后并发症的发生率。     

Ezetimibe for the Treatment of Uncontrolled Hypercholesterolemia in Patients with High-Dose Statin Therapy After Renal Transplantation

We investigated prospectively the efficacy of ezetimibe in addition to statin therapy in stable renal transplant patients in whom hypercholesterolemia was not sufficiently treated. Eighteen renal transplant patients received 10 mg ezetimibe once daily in addition to high-dose statin therapy for uncontrolled hypercholesterolemia. Total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, Tacrolimus (Tac)- and Cyclosporine A (CsA) blood levels, creatinine, urea, liver enzymes, electrolytes and creatinkinase (CK) were measured before initiation of ezetimibe therapy, after 7 days, 6 weeks and 3 months. Cholesterol concentrations decreased significantly (p < 0.005) from 264 +/- 46 mg/dL at baseline to 205 +/- 48 mg/dL after 1 week to 202 +/- 48 mg/dL after 6 weeks and 212 +/- 40 mg/dL after 3 months (reduction after 3 months 21 +/- 10%). LDL-concentrations decreased significantly (p < 0.005) from 178 +/- 41 mg/dL at baseline to 129 +/- 35 mg/dL after 1 week to 123 +/- 25 after 6 weeks and to 117 +/- 40 mg/dL after 3 months (reduction after 3 months 37 +/- 14%). Two patients stopped ezetimibe therapy due to nausea and muscle pain without CK elevation. Significant changes of CsA and Tac blood levels, liver and muscle enzymes were not observed. Ezetimibe seems to be an effective therapy for uncontrolled hypercholesterolemia in renal transplant patients when combined with high-dose statin therapy.     

肾移植患者人工髋关节置换的特点和疗效观察

目的探讨肾移植患者人工髋关节置换的治疗特点,并观察其疗效。方法回顾2006年11月至2009年3月肾移植术后行人工髋关节置换术患者3例（4髋）,对术前评估、术中操作、假体选择、术后免疫抑制方案调整和抗凝等综合治疗进行分析和小结。结果3例患者在围手术期经过综合处理,均未出现移植肾排斥、多器官功能不全、感染和血栓等严重并发症。平均随访3．4年,目前功能恢复良好,无相关并发症。结论肾移植术后患者进行人工髋关节置换术时,由于自身的特殊情况,术前及术后都需进行全面、系统的综合治疗。在保证移植肾充分安全的前提下,才能避免严重并发症的发生,获得人工髋关节置换术的成功。     

Results of Positive Cross-Match Transplantation in African American Renal Transplant Recipients

Positive cross-match (PXM) renal transplantation has been utilized to address the issue of the increasing demand for transplantation with the shortage of suitable organs. Our primary objective was to analyze the outcomes of African American (AA) PXM renal transplant recipients utilizing AA negative cross-match (NXM) renal transplant recipients as a comparator group. This was a retrospective study consisting of all PXM patients who underwent a desensitization protocol and all AA NXM transplant recipients at the University of Illinois at Chicago from July 2001 to March 2007. We found that AA PXM recipients had significantly lower estimated glomerular filtration rate (eGFR) at 1 year than AA NXM (46.2 vs. 60.6, p = 0.007). AA PXM who experienced acute rejection within the first year were more likely to have an eGFR less than 30 mL/min/1.73 m² at 1 year compared to their NXM counterparts (45.5% vs. 12.5%, p = 0.034). Positive cross-match renal transplantation in AA seems to be associated with a high degree of AR and severe renal compromise at 1 year. Larger studies are needed to determine if protocols that are associated with good short-term outcomes in non-AA need to be modified for the AA population.     

Blood Tacrolimus Levels and Calcineurin Phosphatase Activity Early after Renal Transplantation

The toxicity of tacrolimus (FK) despite therapeutic levels (trough) has led us to investigate its relationship with the inhibition of calcineurin (CaN) in recently transplanted renal patients. Twenty-one patients taking FK had blood drawn on day 3 and 14 at 0,1,2,3,4 and 6h. CaN activity was measured by its ability to cleave 32P from a previously radiolabeled phosphorylated 19-amino acid peptide. Radioactivity was quantitated and results were converted to units CaN. FK concentration was measured simultaneously. Maximal suppression of CaN occurred after 2h on both days. Unlike FK levels, CaN activity returned to predose levels by 6h. Comparing mean CaN activity at time 0 with each subsequent time showed statistical significance at hours 1, 2 and 3 on each day. Comparing mean FK concentrations, similarly, revealed statistical significance at all hours. Area under CaN activity curve (AUCCaN) vs. mean FK levels failed to show significance. However, comparing AUCCaN with mean CaN activity was significant throughout. CaN capacity at time 0 and 6h (day 14) resulted in the best estimate of CaN inhibition. Prior to steady-state (day 3), the best estimate occurred at 2h. No single FK concentration seemed to be a reliable indicator of CaN inhibition.     

Valacyclovir Prophylaxis Versus Preemptive Valganciclovir Therapy to Prevent Cytomegalovirus Disease After Renal Transplantation

Both preemptive therapy and universal prophylaxis are used to prevent cytomegalovirus (CMV) disease after transplantation. Randomized trials comparing both strategies are sparse. Renal transplant recipients at risk for CMV (D+/R−, D+/R+, D−/R+) were randomized to 3-month prophylaxis with valacyclovir (2 g q.i.d., n = 34) or preemptive therapy with valganciclovir (900 mg b.i.d. for a minimum of 14 days, n = 36) for significant CMV DNAemia (≥2000 copies/mL by quantitative PCR in whole blood) assessed weekly for 16 weeks and at 5, 6, 9 and 12 months. The 12-month incidence of CMV DNAemia was higher in the preemptive group (92% vs. 59%, p < 0.001) while the incidence of CMV disease was not different (6% vs. 9%, p = 0.567). The onset of CMV DNAemia was delayed in the valacyclovir group (37 ± 22 vs. 187 ± 110 days, p < 0.001). Significantly higher rate of biopsy-proven acute rejection during 12 months was observed in the preemptive group (36% vs. 15%, p = 0.034). The average CMV-associated costs per patient were $5525 and $2629 in preemptive therapy and valacyclovir, respectively (p < 0.001). However, assuming the cost of $60 per PCR test, there was no difference in overall costs. In conclusion, preemptive valganciclovir therapy and valacyclovir prophylaxis are equally effective in the prevention of CMV disease after renal transplantation.     

维持循环系统稳定性对肾移植的重要意义

本文报告肾移植57例。就末次血透时间对肾移植术中及术后早期血压的影响、血压波动范围与移植肾尿量及肌酐恢复的关系作了统计分析。结果表明:术前24h内加强透析的患者,术中及术后血压稳定,生命体征易管理,开放血流后绝大多数移植肾立即泌尿,术后ATN发生率低,透析次数少,肾功恢复恢。血压波动≤4kPa,对移植肾泌尿及其功能恢复有益。血压波动≥5kPa,ATN发生率高,肾功恢复慢,透析过程长。此外,本文就如何保持循环系统稳定性的具体措施作了介绍。强调术中止血彻底是保持血压稳定性之关键。     

Negative Pressure Wound Therapy Used to Heal Complex Urinary Fistula Wounds Following Renal Transplantation into an Ileal Conduit

Transplantation into an ileal conduit is an established option for patients with end‐stage renal failure and a nonfunctioning urinary tract. Urinary fistulae are more common following these complex transplants. Urinary fistula in this scenario can cause substantial morbidity and even result in graft loss. The management options depend on the viability of the transplant ureter, the level of local sepsis and the overall condition of the patient. Urinary diversion with a nephrostomy and ureteric stents has been described in aiding the healing of urinary leaks in renal transplants into a functioning urinary tract. We describe the successful use of negative wound pressure therapy to eradicate the local sepsis and help the healing of a recurrent urinary fistula following kidney transplantation into an ileal conduit. To our knowledge these are the first such cases reported in the literature.