儿童肾移植受者术后生存质量和心理状况现状及影响因素分析

目的  探讨儿童肾移植受者术后生存质量和心理状况现状并分析其影响因素。 方法  选取96例儿童肾移植受者为研究对象,收集受者的一般资料,采用儿童生存质量量表（PedsQL^TM3.0）评估其生存质量,采用长处和困难问卷（SDQ）评估其心理状况,对儿童肾移植受者术后生存质量和心理状况的影响因素进行单因素和多因素分析。 结果  儿童肾移植受者术后生存质量总分为（71±14）分,困难总分为（12.4±5.8）分。单因素分析结果显示,性别、术后体质量指数（BMI）和肾移植术后并发症是儿童肾移植受者术后生存质量总分的影响因素（均为P < 0.05）;性别、肾移植术后并发症和肾移植术后随访时间是儿童肾移植受者困难总分的影响因素（均为P < 0.05）。多因素分析结果显示,性别、术后BMI、肾移植术后并发症、肾移植前透析种类是儿童肾移植受者术后生存质量的影响因素,性别、肾移植术后并发症、肾移植术后随访时间是儿童移植受者术后心理状况的影响因素（均为P < 0.05）。 结论  儿童肾移植受者术后生存质量和心理状况较好,临床中应重点关注女性、术后BMI偏低、肾移植术后出现并发症及肾移植术后随访时间较短的患儿,预防性给予干预措施,进一步提高生存质量。     

微机辅助肾移植受者术后随访质量管理

目前我国长期存活的肾移植受着人数在逐年增加，但是全国各移植中心开展这项工作的水平及质量并不均衡，移植经验未及时得到广泛交流，另外，限于人力、物力各方面的因素，肾移植术后的常规随访工作无法普遍开展，使我国肾移植受者长期存活率远远低于世界水平。我院自1977年首例肾移植成功后，近20年来共行肾移植术900余例次，从80年代末期由经验丰富的临床医师对肾移植受者作定期随访，收效很大，肾移植受者的康复率显著提高、但随着移植例数的逐年递增，参与常现随访的肾移植受者人数也不断扩大（表1），门诊随访人数1990年有227例，至199…     

对27例亲属供肾移植中供者的术后随访

目的探讨活体亲属供肾移植中供者手术的安全性及术后的生活质量。方法总结2001年12月至2005年9月间27例亲属活体供肾的切取方法，其中6例采用开放式经后腹腔切取供肾，21例采用经后腹腔镜下切取供肾。术后对27例供者随访14～60个月，比较供者术前及术后不同时间段的血肌酐（Cr）、尿素氮（BUN）、血糖及血压的变化情况；根据SF-36健康评分调查和25条问卷题目观察供者的生活质量。结果成功地完成了对27例亲属供者的供肾切取。21例经腹腔镜下取肾术无1例中转开放。手术时间为60～180min，术中失血量为20～200ml，术后住院时间为3～7d。27例供者术后近期各项观察指标虽较术前有变化，但差异均无统计学意义（P〉0．05）。健康评分结果显示供者生活质量满意。结论活体供肾切取手术是安全可行的。术前进行详细的检查、术中仔细操作以及术后长期随访对于供者的安全有十分重要的意义。     

肾移植受者术后生育问题

肾移植受者术后生育一直是移植界和生殖界专家关注的重要课题,本文结合目前文献重点对生育时机的选择、生育对移植肾以及免疫抑制剂对生育的影响等问题进行综述.     

女性肾移植受者妊娠结果及子代健康状况随访

目的 评价女性肾移植受者妊娠结果及子代健康状况的长期随访结果. 方法 回顾性分析1978年4月至2011年4月妊娠＞5个月的15例肾移植受者资料,并对其子代进行随访.妊娠时年龄(28.5±5.7)岁,妊娠距移植时间(53.4±19.7)个月.产后随访(11.5±6.9)年. 结果 15例受者采用以环孢素或他克莫司为主的免疫抑制剂方案.12例母、子女身体状况及移植肾功能正常;1例产下一男婴2周后因并发肺部感染、心力衰竭,带正常功能移植肾死亡;2例分别于妊娠第21、23周发生移植肾慢性排斥反应,终止妊娠,经治疗无效后摘除移植肾.13例胎儿均经剖宫产娩出后存活,胎龄(35.2±4.0)周,出生体质量(2510 ±68)g,Apgar评分均为10分.13例婴儿出生时无生理缺陷,体格发育无异,出生后以人工喂养.13例儿童智力、体格以及心理发育与同龄者无异常,7例0～2岁时发生反复呼吸道感染,1例诊断为注意力缺陷多动障碍.目前子代年龄3 ～21岁. 结论 严格妊娠指征,肾移植女性受者在术后3年后能够成功妊娠、分娩,长期随访显示患者子代健康状况良好.     

免疫抑制剂对肾移植受者术后并发恶性肿瘤的影响

目的观察肾移植术后恶性肿瘤的发生情况及免疫抑制剂对其发生的影响。方法回顾性分析1996年1月至2006年12月在济南军区总医院进行同种异体肾移植的852例受者中39例发生恶性肿瘤患者的临床资料,将其分为硫唑嘌呤（AZA）组（n=12）和吗替麦考酚酯（MMF）组（n=27）,应用Kaplan-Meier法估计并绘制两组生存曲线,用log-rank法比较两组生存率,分析免疫抑制剂对并发恶性肿瘤患者生存的影响。结果 852例肾移植受者术后恶性肿瘤总发生率为4.6%（39/852）,其中泌尿系统肿瘤占74.4%（29/39）、消化系统肿瘤占15.4%（6/39）、肺癌占7.7%（3/39）、皮肤癌占2.5%（1/39）。3年无病生存率AZA组为83.1%,MMF组为81.1%;平均生存时间AZA组为（64±8）个月,MMF组为（53±4）个月;两组3年无病生存率及平均生存时间比较差异均无统计学意义（P=0.16,P=0.61）。使用两种不同免疫抑制剂的肾移植术后并发恶性肿瘤患者的病死率差异无统计学意义（χ2=0.075,P〉0.05）。结论肾移植术后并发恶性肿瘤仍以泌尿系统肿瘤为主。AZA与MMF两种免疫抑制剂对肾移植术后并发恶性肿瘤的影响没有明显区别。     

219例活体肾移植供者长期随访分析

目的 探讨活体肾移植供者术后生存质量及恢复情况.方法 对2004年以来219例肾脏捐献超过1年的亲属活体肾移植供者进行随访,评估供者的肾功能、并发症发生情况及生活质量.结果 供者捐肾时年龄为(43.3±11.6)岁(19～66岁),随访时间为术后12～103个月,随访截止时供者存活率为100％.术后稳定期(1年后)供者血清肌酐(Scr)为(84.0±18.7)μmol/L,内生肌酐清除率(Ccr)为(1.23±0.37)ml/s.＞50岁者术后1周及1年后Ccr低于年龄≤50岁者(P＜0.01,P＜0.05).3例供者术后Scr未降至正常范围,其肾脏捐献时年龄＞55岁.术后并发症包括高血压30例(其中5例为术后新发),镜下血尿4例,高脂血症3例,轻度贫血2例,股骨头坏死1例.总体感觉肾脏捐献对健康有影响者共40例,认为肾脏捐献对健康有轻度影响者31例,有较明显影响者7例,有严重影响者2例;偶尔觉伤口疼痛31例,经常感觉伤口疼痛4例.结论 供者肾脏捐献后中长期安全性和生存质量良好,但仍存在肾功能异常风险,尤其是高龄供者,需密切随访.供者随访依从性需进一步提高.     

尸肾移植受者和亲属活体肾移植受者术后焦虑抑郁的比较

目的 了解尸肾移植受者和亲属活体肾移植受者术后焦虑抑郁状况.方法 采用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对71例尸肾移植受者(尸肾组)和74例亲属活体肾移植受者(活体组),于移植术后第3个月进行问卷调查.结果 两组SAS、SDS评分显著高于常模(均P＜0.01);活体组SAS评分显著高于尸肾组(P＜0.01).活体组焦虑、抑郁阳性率显著高于尸肾组(均P＜0.05).结论 肾移植受者术后焦虑抑郁普遍存在.亲属活体肾移植受者术后焦虑抑郁较尸肾移植受者更严重.     

尸肾移植受者和亲属活体肾移植受者术后焦虑抑郁的比较

目的了解尸肾移植受者和亲属活体肾移植受者术后焦虑抑郁状况。方法采用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对71例尸肾移植受者（尸肾组）和74例亲属活体肾移植受者（活体组）,于移植术后第3个月进行问卷调查。结果两组SAS、SDS评分显著高于常模（均P〈0．01）;活体组SAS评分显著高于尸肾组（P〈0．01）。活体组焦虑、抑郁阳性率显著高于尸肾组（均P〈0．05）。结论肾移植受者术后焦虑抑郁普遍存在。亲属活体肾移植受者术后焦虑抑郁较尸肾移植受者更严重。     

Health-related quality of life and symptom experience in tacrolimus-based regimens after renal transplantation: a multicentre study

Tacrolimus is increasingly used as a baseline immunosuppressant after renal transplantation. This multicentre study assessed health-related quality of life and symptom experience in renal transplant patients on tacrolimus-based therapy, using the SF-36 and Euroqol 5 dimensions (EQ-5D) and the 'modified transplant symptom occurrence and symptom distress scale', respectively. Symptoms of depression were assessed with the short form of the Beck Depression Inventory and physical activity with the Baecke questionnaire. Overall, 350 patients with a median post-transplant status of 16.7 months were enrolled. Results revealed that patients experienced lower SF-36 scores than the general population, except in terms of bodily pain. Univariate and multivariate analyses demonstrated that a higher degree of depressive symptoms and female gender were consistently related to a health status perceived as being worse and a higher rate of symptom experience. These findings are in accordance with previous quality-of-life reports that assessed patients under various immunosuppressive therapies. Therefore, interventions, including the screening and treatment for depression and the addressing of gender-specific issues, can enhance quality of life.     

Growth after renal transplantation

Growth may be severely impaired in children with chronic renal insufficiency. Since short stature can have major consequences on quality of life and self-esteem, achieving a ‘normal’ height is a crucial issue for renal transplant recipients. However, despite successful renal transplantation, the final height attained by most recipients is not the calculated target height. Catch-up growth spurts post-transplantation are usually insufficient to compensate for the retardation in growth that has occurred during the pre-transplant period. Longitudinal growth post-transplantation is therefore influenced by the age at transplantation but also by subsequent allograft function and steroid exposure, both of which interfere with the growth hormone/insulin-like growth factor axis. The management of growth retardation in renal transplant recipients includes adequate nutritional intake, correction of metabolic acidosis, prevention of bone disease, steroid-sparing strategies and a supraphysiological dose of recombinant human growth hormone in selected cases.     

影响肾移植患者生存质量的因素调查

目的分析影响移植后生存质量的因素。方法使用SF36量表与肾脏病相关的生存质量(KDTA)组合起来的一般/特殊性量表KDQOLSFTM评价尿毒症患者肾移植前及肾移植后6个月的生存质量。结果肾移植术后6个月,患者的SF36量表的8个维度(包括体能、体力所致工作和生活受限、疼痛、总体健康状况、精力状况、社会功能、情感问题对工作生活的影响及情感状况)和KDTA的8个方面(包括症状与不适、肾病对日常生活的影响、肾病给生活带来的负担、工作状况、性功能、睡眠、社会支持及患者满意度)的评分较移植前有明显提高,经济水平、合并症、住院事件、年龄、肌酐水平是肾移植患者生存质量的独立影响因素。结论肾移植能改善尿毒症患者的生存质量;影响肾移植患者生存质量的因素是多方面的。     

Effect of kidney transplantation on quality of life measures

Assessing the quality of life should be an essential part of the long-term results of surgery, particularly for those procedures that may influence a patient's lifestyle and body image. Eliminating the need for dependence on chronic hemodialysis, kidney transplantation improves the patient's autonomy but exposes them to the side-effects of immunosuppression and the constant threat of rejection. The purpose of this study was to compare the quality of life of patients on the waiting list for a kidney transplantation to that of those already transplanted at our Center to quantify carefully the impact of this therapy on the patient's physical, emotional, and social well-being. Computer analysis of the data collected from self-administered questionnaires revealed that the vast majority of successfully transplanted patients experience a significant improvement in almost all the areas investigated compared with the pretransplant group. In addition, we tried to use the questionnaire to predict which type of patient will adjust more fully to the impact of a kidney transplantation and which will probably need posttransplant psychological care and social support. Aside from clinical factors such as the time spent on hemodialysis before transplantation, the gender, the age, as well as the source of the organ (living vs. cadaver donor) seem to play a role in the final outcome of a successful kidney transplantation.     

Quality of life before and after liver transplantation: experiences with 7 patients with primary biliary cirrhosis in a 2-year follow-up

Seven patients with end-stage primary biliary cirrhosis were evaluated both before and 1 and 2 years after liver transplantation using a clinical psychiatric interview and the self-rating questionaire SCL-90. Neuro-psychological tests were done before and 1 year after operation. Preoperatively, all patients had a poor general condition and overall quality of life. Flattening of emotions and reactions, regression, disturbances of verbal memory and cognitive function, and dependence on close relatives were observed. One year after transplantation, 6 patients had a much better overall quality of life, and with five patients it improved still further during the 2nd year, but only 2 patients felt that their life situation had fully stabilised. However, nearly all of them experienced phases of moderate or even severe depression or anxiety during those 2 years. On neuropsychological tests patients appeared to be near their normal level. The only patient who died during this follow-up (some months after transplantation) had in her life history a prominent sense of insecurity and mistrust. It seems to take more than a year for the majority of patients to give up the regressive mode of experience and turn to adult interests in life again, as well as psychologically experience the new liver as part of oneself.     

Health-related quality of life after hand-assisted laparoscopic and open radical nephrectomies of renal cell carcinoma

Aim  To compare the health-related quality of life (HRQOL) in contemporaneous groups of patients undergoing hand-assisted laparoscopic radical nephrectomy (HALRN) or open radical nephrectomy (ORN) for renal cell carcinoma (RCC). Patients and methods  The clinical data of 20 cases receiving hand-assisted laparoscopic radical nephrectomy (the HALRN group) and 51 cases receiving open radical nephrectomy (the ORN group) were analyzed retrospectively and health questionnaires were mailed to these patients at 1 year postoperatively. The two groups were compared in terms of general surgery-related information, tumor characteristics, days to return to work or routine daily activities, and health-related quality-of-life scales. Results  Patients in the HALRN group had significantly less mean incision length (6.25 versus 17.8 cm), faster return to work or routine daily activities (5.3 versus 8.6 weeks), and earlier out-of-bed activity (4.76 versus 6.59 days) compared with those in the ORN group (P < 0.05). There were no significant differences in HRQOL scales at 1 year between the both groups (P > 0.05). Conclusion  The results showed that hand-assisted laparoscopic surgery is a minimally invasive surgical technique for RCC offering earlier recovery and similar long-term HRQOL compared with open surgery.     

Outcome after renal transplantation. Part II: Quality of life and psychosocial adjustment

Knowledge of health-related quality of life (QOL) and psychosocial adjustment (PA) in children after renal transplantation (RTPL) is limited. QOL and PA were evaluated by standardized tests in patients after RTPL. Thirty-seven children of median age 14.5 years (range 6.5-17 years) were investigated a mean 4.5 years (range 0.5-12.8 years) after RTPL. Child- and parent-rated QOL was evaluated with the Child Quality of life Questionnaire of The Netherlands Organization for Applied Scientific Research Academical Medical Centre (TNO-AZL). PA was assessed by the Child Behaviour Checklist (CBCL) providing parental reports of a child's behaviour. In patients' self-ratings, the QOL dimension physical complaints (P < 0.0005) scored significantly better than that of healthy controls, whereas the dimension positive emotional functioning was impaired (P = 0.02). Parents rated motor functioning (P = 0.002), autonomy (P = 0.01), cognition (P = 0.04) and positive emotions (P < 0.0005) as significantly impaired. Parents also assessed PA significantly (P = 0.02) impaired with regard to internalizing behaviour. Dialysis duration, young age at RTPL, living-related donation, steroid treatment, adverse family relationships and maternal distress had a significantly negative impact on QOL and PA (P < 0.05). Patients rated QOL higher than did healthy controls. Parents evaluated their children's QOL and PA more pessimistically than did the patients themselves. Both illness-related variables and family environment played an important role.     

活体肝移植供者生活质量调查研究

目的调查活体肝移植供者的生活质量,了解影响该人群生活质量的因素。方法应用调查研究设计,采用中文版SF-36生活质量量表调查活体肝移植供者的生活质量。结果 18例供者躯体相关生活质量分为84.78±13.21,心理相关生活质量分为80.71±14.65,总分为165.49±22.63。在＂总体健康＂、＂活力＂维度上的得分中青年组高于中年组（P〈0.05）,在＂躯体疼痛＂维度上的得分男性组高于女性组（P〈0.05）。结论活体肝移植供者的生活质量与正常人群接近。供者年龄是影响术后生活质量的因素。     

Assessment of female sexual function and quality of life in predialysis,peritoneal dialysis,hemodialysis, and renal transplant patients

Introduction  Chronic renal failure (CRF) and renal replacement treatments have a negative effect on sexual function and quality of life (QoL). The literature on female sexual dysfunction (FSD) in patients with CRF is limited. The aim of this study is to compare the sexual function and QoL in predialysis (PreD), dialysis, and transplant patients. Materials and methods  A total of 106 women including 21 PreD, 45 dialysis, 20 renal transplantation (Tx), and 20 control patients were enrolled in the study. The Female Sexual Function Index (FSFI) and SF-36 scales were used to assess all patients, and demographic and clinical variables were documented. The FSFI and QoL scale scores were compared among the groups. Results  The rates of FSD were 50, 81, 66.7, 75, and 50% in the control, PreD, peritoneal dialysis (PD), hemodialysis (HD) and Tx patients respectively. Total FSFI scores for desire, arousal and orgasm scores in the PreD group were significantly lower than those in Tx and control patients (P < 0.05). Physical components of QoL in CRF patients were significantly worse than in the control group (P < 0.0001). On logistic regression analysis, age, glucose and creatinine were significantly associated with FSD. Conclusion  This preliminary study documented that Tx is the most effective way to retain good sexual function in women, and a diagnosis of FSD should be made routinely in CRF patients.     

117例亲属肾移植供者术后生活质量调查及多因素分析

目的 探讨亲属肾移植供者术后生活质量及相关影响因素,为提高供者术后生命质量提供参考依据.方法 运用横断面调查研究方法以统一印制的调查表对本中心2006-2008年所实施的1 17例亲属肾移植供者术后实施问卷调查,并以同期健康人群作为对照组.调查内容包括社会人口学特征、手术并发症、经济状况、对亲属活体肾移植知晓状况、家庭支持情况、医疗保障及社会福利、术后日常锻炼等,以中文版SF-36量表测定生活质量.以t检验、方差分析和逐步回归对每一种影响因素进行分析.结果 亲属肾移植供者心理健康高于健康人群(P＜0.05);生活质量总分及其他各维度评分与健康人群比较,差异无统计学意义(P均＞0.05).单因素分析时,年龄、文化程度、经济状况、体育锻炼等4种因素与生活质量的多个领域均有关系.进一步多因素分析,在排除了各因素之间的相互影响后,对供者术后生活质量的主要影响因素分别是文化程度、经济状况、体育锻炼(P＜0.05).结论 术前应从社会心理等多角度对供者进行严格筛选,良好的社会心理背景、必要的心理指导及术后定期随访是保障供者术后良好生活质量的关键.