亲属活体肾移植75例报告

目的通过对75例活体亲属肾移植的实施、观察及随访结果,探讨活体亲属肾移植供体选择指征和治疗经验。方法分析总结1999年3月～2009年7月我院实施的75例亲属活体肾移植的供受者临床资料、风险评估、配型、手术方法及免疫抑制剂方案。结果4例供者术中轻度胸膜损伤,经及时处理无不良后果,1例供者术后发生乳糜淋巴瘘,引流2w后痊愈,其余供者术后未出现并发症,术后肾功能正常。75例受者中有不同程度的排斥反应、移植肾功能延迟恢复、感染等并发症。结论亲属活体肾移植急性排斥反应明显低于尸体肾移植,具有近期移植肾功能恢复好、经济代价小的优势,移植肾长期存活效果还有待随访观察,活体供肾也存在一些伦理学的争议。     

亲属活体肾移植供者围手术期的护理

目的研究亲属活体供肾移植供者围手术期的护理问题,提高亲属活体供肾移植术成功率。方法对活体供肾移植中102名供者进行术前的心理护理,术前、术后的准备,加强对并发症的精心护理。观察手术疗效、供者心理和身体的恢复情况。结果全部102例亲属活体供者左肾摘取术均成功,术后1周内血Cr、BUN均下降至正常值范围,全部顺利度过围手术期,术后9～13天出院,正常生活。3例发生切口愈合不良,经对症处理及行二期清创缝合后,切口完全愈合。1例术后出现短暂的血Cr升高,最高达428μmol/l,一周后下降至108μmol/l。其余98例供者无任何相关并发症。供者术前、术后心理健康,尤其在术后无明显心理问题出现。结论亲属活体供肾摘取术成功率高,通过围手术期的精心护理更能使供肾者减少相关的并发症,使身心早日康复。     

亲属活体肾移植供者围手术期的护理

目的研究亲属活体供肾移植供者围手术期的护理问题,提高亲属活体供肾移植术成功率。方法对活体供肾移植中102名供者进行术前的心理护理,术前、术后的准备,加强对并发症的精心护理。观察手术疗效、供者心理和身体的恢复情况。结果全部102例亲属活体供者左肾摘取术均成功,术后1周内血Cr、BUN均下降至正常值范围,全部顺利度过困手术期。术后9～13天出院,正常生活。3例发生切口愈合不良,经对症处理及行二期清创缝合后,切口完全愈合。1例术后出现短暂的血Cr升高,最高达428μmol／l,一周后下降至108μmol／l。其余98例供者无任何相关并发症。供者术前、术后心理健康,尤其在术后无明显心理问题出现。结论亲属活体供肾摘取术成功率高,通过围手术期的精心护理更能使供肾者减少相关的并发症。使身心早日康复。     

亲属活体肾移植受者肾功能延迟恢复的护理

目的探讨亲属活体肾移植受者肾功能延迟恢复的观察和护理。方法对3例亲属活体肾移植术后肾功能延迟恢复患者的进行病情观察和护理总结。结果 3例患者肾功能恢复正常。结论精心的治疗和护理可有效预防各种并发症的发生,有利于肾功能的恢复。     

亲属供肾活体肾移植22例报告

目的总结22例亲属活体肾移植的经验。方法22例亲属活体肾移植除1例为夫妻间供肾外，其余均为血缘亲属供肾。19例取左肾，3例取右肾，均为开放手术取肾，术后采用环孢素A（CsA）、硫唑嘌呤（Aza）或酶酚酸酯（MMF）及泼尼松（Pred）预防排斥反应。结果所有供者于术后10～14d出院，随访8～29个月，血肌酐正常，22例受者全部存活，术后发生肾功能延迟恢复1例；急性排斥反应1例，经甲基强的松龙冲击治疗后逆转；2例分别于术后2个月和4个月发生白细胞减少症，经治疗后白细胞正常；无外科并发症；现所有受者肾功能均正常。结论亲属活体肾移植优点明显，是解决肾源紧缺困境的现实途径。     

亲属活体肾移植受者的健康教育需求调查与管理

世界上第一例成功的肾移植即为亲属活体肾移植，在供肾短缺Et益加剧的今天，亲属活体肾移植重新成为移植界关注的焦点。相对于尸体肾移植，亲属活体肾移植具有更好的人／肾的存活率；但亲属活体肾移植受者的心理压力较大，更担心手术成功率及预后情况。     

亲属活体肾移植术的手术配合

目的总结亲属活体肾移植术的手术配合。方法回顾性总结27例亲属活体肾移植术的手术过程和手术配合。结果27例亲属活体肾移植术麻醉及手术过程均顺利,术中无护理并发症,术后均获得满意的治疗效果。结论通过对27例亲属活体肾移植术的手术配合,使我们体会到术前充足的准备和术中密切的配合是手术成功的重要因素。     

亲属活体肾移植老年供体安全护理体会

目的:探讨亲属活体肾移植年龄≥55岁老年供者健康安全的护理体会。方法:选择某医院实施亲属活体肾移植68例,≥55岁的老年供体40例。分析40例老年供体的临床资料,术前、术后的护理记录和临床化验指标。结果:40例老年供体平稳度过手术,无并发症发生,近期身体状况恢复良好。结论:供肾手术是安全的,老年供体术前评估很重要,心理护理能使其平稳接受手术,严格的围手术期护理是观察、发现和减少并发症的重要环节。     

97例亲属活体肾移植供者围手术期的护理体会

<正>肾移植是现在国内外治疗慢性肾衰竭的最佳方案,然而供体肾脏的短缺与日渐增多的尿毒症患者之间的矛盾成为肾移植事业发展的瓶颈,为了解决这一难题,亲属活体肾移植成为国内外近来年肾移植的趋势。我院2010年8月-2012年8月共行亲属活体肾移植97例,所有供者术后恢复好,均顺利出院,现将围手术期护理报告如下。     

13例活体供肾肾移植临床分析

目的探讨活体供肾肾移植手术的临床效果及可行性、安全性。方法回顾分析13例活体供肾肾移植临床资料。结果13对供受者全部存活。所有移植肾肾功能均在术后2~4 d恢复正常,无肾功能延迟恢复,1例受体术后10 d发生急性排斥,抗排斥治疗逆转。人/肾1年存活率100%;13例供体术后无严重并发症,10 d内出院。结论活体供肾肾移植安全可行,效果优于同期尸体供肾移植,且能缓解肾源短缺的状况。     

亲属活体肾移植受者阶段性健康教育效果评价

目的对亲属活体肾移植受者阶段性健康教育效果作出科学评价,同时使受者系统了解。肾移植手术相关知识,积极配合治疗护理,提高生存质量。方法采用随机分组,将48例受者随机分为实验组（24例）和对照组（24例）,实验组实施阶段性健康教育,对照组按常规进行健康教育。结果实验组对肾移植及手术的相关知识掌握程度显著高于对照组（X^2=8．83,P〈0．05）,对护理工作的满意度实验组也明显高于对照组,差异有统计学意义（X^2=10．32,P〈0．05）。结论阶段性健康教育能提高受者对肾移植的认识,从而促进身心康复,提高受者生存质量。     

肾脏移植术后并发精神障碍的护理

目的:介绍肾脏移植患者术后出现精神障碍的护理体会.方法:探讨该并发症的诱发因素,制定并实施针对性的护理.结果:4例患者经对症治疗和护理后,症状均消失.结论:实施有效的围手术期健康教育,帮助患者学会出院后的自我护理,可以提高肾脏移植患者的生活质量.     

活体小肠移植围手术期的营养调控

目的: 探讨如何恰当地对活体小肠移植病人进行围手术期的营养调控. 方法: 根据4例活体小肠移植病人术后移植肠的功能恢复程度和全身状况,采用从PN逐步过渡至EN的营养支持方法.同时观察病人术后1周、1、3、6和9个月的临床指标和实验室指标,并进行营养状况评估. 结果: 4例病人中2例长期生存,分别达8年和4年,各项营养指标均基本恢复正常,健康状况良好;1例术后19 d死于急性肺梗死,1例术后5个月死于多发性器官感染. 结论: EN支持可促进移植肠功能的恢复,减少或减轻并发症,提高活体小肠移植的成功率.Gln是EN液中的重要成分.     

下尿路异常患者的肾脏移植（附4例报告）

目的探讨下尿路异常患者肾脏移植的特点。方法2002年7月-2006年6月接受肾脏移植手术的下尿路异常患者4例。肾脏移植术前对患者进行仔细评估，手术中将移植肾输尿管再植入患者膀胱中，术后监测移植肾功能、尿常规、排斥反应情况，并对患者的生活质量满意度进行评价。结果2例患者术后肾功能恢复良好，未发生排斥反应，能够自行更换导尿管，有轻度尿路感染，控制满意，生活质量满意度良好。1例患者术后17d发生急性排斥反应，治疗后逆转，带有功能移植肾存活至今。1例患者术后因血管吻合部位反复出血导致移植肾丢失，恢复血液透析治疗。结论下尿路异常患者可以进行肾脏移植，但具有特殊性，仔细的术前评估、适当的尿液引流方式以及严密的术后随访是此类患者肾脏移植成功的关键。     

Langzeitüberleben bei chronischer Niereninsuffizienz

Patients with end-stage renal disease require renal replacement therapy with either dialysis or kidney transplantation. Survival and quality of life (QoL) after transplantation are superior to chronic dialysis. Early living donor kidney transplantation is best for patient and graft survival. Preemptive living-related kidney transplantation therefore is the best medical treatment option for these patients. Patients with end-stage renal disease suffer from multiple physical and psychological complaints. The prevalence of depressive disorders is 20-25% in this population. Studies on QoL in children after kidney transplantation show a reduced physical QoL, but an overall good psychological QoL. Alarming results of numerous studies are the high non-adherence rates in adolescents. Especially exercise interventions during dialysis and after kidney transplantation show promising results. Whether QoL of patients will improve with new approaches to immunosuppressive therapy remains to be evaluated in future studies.     

“We’re not going to say it’s suffering; we’re going to say it’s an experience”: The lived experience of maternal caregivers in pediatric kidney transplantation

Advances in the surgical and immunological aspects of pediatric kidney transplantation have resulted in significant improvements in long-term outcome and survival rates. However, there continues to be a negative impact reported on overall family functioning despite the reported good health and quality of life for the transplanted child. This research utilizes a phenomenological approach to examine the lived experiences of seven mothers of children who had undergone kidney transplantation. Findings of the study illuminate that the experience of mothering in the context of pediatric kidney transplantation is reflected in (1) the significance of relationships to the experience of self; (2) the lived experience of time; and (3) opportunities for growth and personal development. This research identifies that, while maternal caregiving in this context is fraught with challenges, there are opportunities for the development of skills and personal growth within the experience. By embracing a strength-based perspective, social work is well positioned to offer support for maternal meaning-making and adjustment during times of stress and uncertainty.     

Quality of life after liver transplantation for hepatitis C infection

Introduction Transplantation is a life-saving option for patients with liver disease. However, recovery is variable. Impairments in physical health, emotional wellbeing and quality of life are reported. Quality of life may be worse after transplantation for hepatitis C virus (HCV) infection. Objective To identify factors that could impact on quality of life after liver transplantation for HCV infection. Methods A qualitative design was used. Data were collected by in-depth interview. Colaizzi’s framework for data analysis was used. Results Varying levels of physical and psychological disability persist for many years after liver transplantation. Participants described living productive and meaningful lives. Many reported a more positive outlook on life since transplantation. Many felt stigmatised by the association of liver disease with alcohol/drug misuse. Participants described the uncertainty of life after transplantation. While all expressed gratitude to the donor, emotional responses to the donation varied. Conclusions Transplant recipients exchange one health state for another. Pre-transplant preparation should encourage realistic expectations of life after transplantation. Before transplantation, potential recipients should be given an opportunity to discuss the donation process. This may reduce the burden of emotional debt experienced by some recipients. Feelings of stigma and future uncertainty may be worse for transplant recipients with HCV. A qualitative approach can provide deeper insight into issues affecting quality of life after transplantation for HCV, and explain some of the ambiguous and contradictory findings of previous quantitative studies.