肾移植术后妊娠3例报告

目的 探讨影响肾移植患者妊娠、分娩的相关因素.方法 结合国内、外最新的相关文献,回顾性分析我院3例肾移植患者成功妊娠、分娩的临床资料.结果 2例患者在妊娠的后期出现轻度贫血,血红蛋白分别为95g/L和94 g/L;2例患者出现高血压,血压分别达170/120 mm Hg和140/100 mm Hg;1例患者出现血糖增高,空腹血糖达8.25 mmol/L;1例患者出现移植肾功能损害,血清肌酐达459.68μmol/L.结论 虽然肾移植患者妊娠为高危妊娠,但只要选择合适的受孕时机,及时处理妊娠并发症,合理选择和使用免疫抑制剂,仍可获得满意的效果.     

肾移植术后妊娠4例

1病例资料本组4例患者来自我院(1994/2004)468例肾移植术后患者,妊娠时年龄(27.5±2.3)岁,妊娠距肾移植时间(30.2±10.5)mo,原发病3例为慢性肾小球肾炎,1例为1型糖尿病.均为首次移植患者,供肾热缺血时间(6.0±2.1)min,冷缺血时间(8.4±1.2)h,供、受者ABO血型相容,淋巴细胞毒性试验阴性.     

同种异体肾移植术后妊娠分娩1例报道

肾移植是治疗慢性肾衰有效的方法.有不少育龄妇女未孕而术后随着肾功能改善及生育机能的恢复,希望生育.因此,肾移植术后的生育问题已成为产科医师面临的一个课题.现将我院异体肾移植术后妊娠分娩1例报道如下.     

肾移植术后妊娠的围生结局5例报告

目的 探讨肾移植患者的妊娠结局及其相关因素.方法 回顾性分析我院2000年1月至2007年12月5例肾移植患者的6次妊娠,收集患者的产科资料、移植相关并发症、血肌酐水平、血压、分娩情况,随访新生儿、患者移植肾的结局.结果 5例患者6例次妊娠,4例次期待妊娠,其中2例次妊娠成功,分别于孕37周及孕36周分娩,新生儿出生体重分别为3025g和3070g.新生儿无明显异常.2例次妊娠因重度子痫前期在孕中期行治疗衵引产,其中1例受孕后降低免疫抑制剂的用量,引产术后两年肾功能进行性受损,1年后实施了对侧肾移植术;另1例患者受孕后停用免疫抑制剂,在孕中期出现重度子痫前期、心力衰竭、重度贫血、肾功能恶化,行治疗性引产.结论 肾移植是生育年龄终木期肾脏疾病患者最好的治疗方式,但妊娠对于孕妇、胎儿、新生儿及移植肾都有一定的危险.孕期降低或停用免疫抑制剂是不良妊娠结局的重要原因.肾移植患者妊娠最常见的妊娠并发症是子痫前期.     

肾移植术后发生回肠穿孔2例报告并文献复习

目的报告2例肾移植术后回肠穿孔并发症,探讨相关危险因素。方法回顾性分析2例肾移植术后回肠穿孔的临床资料,并复习有关文献进行讨论。结果回肠穿孔1例发生在术后第7天,1例发生在术后第19天,发病前均有饮食不洁及暴饮暴食史,临床有腹泻、腹痛及肠梗阻等急腹症表现,经剖腹探查明确回肠穿孔,行肠穿孔修补术,术后应用低剂量抗排异药物,加强引流及抗感染措施,2例患者均治愈,随访4-40个月恢复良好。结论肾移植术后暴饮暴食及饮食不洁可能诱发肠穿孔,应尽可能避免;早期诊断及手术治疗可以改善预后。     

肾移植相关型kaposi肉瘤1例报告并文献复习

Kaposi肉瘤是少见的 ,来自于脉管组织的软组织肉瘤 ,临床上比较罕见 ,而肾移植术后并发Ka posi肉瘤更为罕见 ,仅占肾移植病人的 0 .5 2 %左右[1～ 3] ,国内近期仅见 8例报道[2～ 7] ,国外报告也不多 ,现将我院收治的 1例报告如下 ,并结合系统的文献复习 ,探讨肾移植相关型Kaposi肉瘤的病因、诊断和治疗。1　临床资料病人系男性 ,年龄 5 7岁 ,因患肾移植相关型ka posi肉瘤于 2 0 0 2年 4月 13日～ 8月 3日在我院诊治 ,现将病情报告如下 :患者因发现双肾输尿管多发结石并双肾积水 ,于 1984年先后 2次在我院泌尿外科手术治疗 ,术后肾功能逐渐…     

肾移植术后顽固性呃逆1例报告

<正>呃逆症是膈肌和肋间肌等辅助呼吸肌的阵挛性不随意挛缩,伴吸气期声门突然闭锁,空气迅速流入气管内,发出特异性声音。呃逆频繁或持续48 h以上,称为顽固性呃逆。移植术后患者频繁呃逆症状,严重消耗患者的体力、影响患者睡眠,对经手术创伤抵抗力低下的机体造成二次伤害;还可能造成切口裂开、引流增多等情况影响疾病及手术伤口的康复;甚至引起急性呼吸窘迫综合征,严重时甚至会造成患者休克危及生命[1]。我科于2013年2月收治1例尿毒症患者,行同种异体肾移植术,术后并发顽固性呃逆,经过积极的原因分析,实施及时有效的护理对策,干预效果满意,现报告如下。     

肾移植术后并发鼻中隔脓肿2例附文献复习

鼻中隔脓肿多由鼻中隔血肿合并感染所致。鼻中隔血肿是指鼻中隔一侧或两侧软骨膜下或骨膜下积血,因鼻中隔软骨膜或骨膜为一坚韧而致密的结缔组织,不易穿破,若其下有出血时较易积蓄而形成血肿[1]。较小的血肿多可被吸收而消失,较大者的形成纤维化而使鼻中隔增厚,如既发感染,则可变为鼻中隔脓肿,导致软骨坏死,形成鞍鼻。鼻中隔血肿多见于鼻中隔矫正术后及鼻外伤后,自发性血肿罕见,     

肾移植后并发急性出血坏死性胰腺炎1例报告及文献复习

急性胰腺炎(acute pancreatitis,AP)是肾移植术后罕见并发症,肾移植术后AP的发病率约为2％～7％,尤其是急性出血坏死性胰腺炎,治疗困难,死亡率高.本文报告1例肾移植术后并发急性出血性坏死性胰腺炎并致死亡的病例并结合文献复习,分析其诱发因素,探讨其预防和治疗措施.     

肾移植术后感染新型冠状病毒1例

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.     

肾移植术后感染新型冠状病毒1例

The novel coronavirus is a newly discovered pathogen in late December 2019, and its source is currently unknown, which can lead to asymptomatic infection, new coronavirus pneumonia or serious complications, such as acute respiratory failure. Corona virus disease 2019 (COVID-19) is a new type of respiratory disease that is currently spreading all over the world and caused by this coronavirus. Its common symptoms are highly similar to those of other viruses, such as fever, cough and dyspnea. There is currently no vaccine or treatment for COVID-19. Everyone is susceptible to infection with this disease, and owing to the long-term use of immunosuppressants, the immunity of kidney transplant recipients is suppressed, and it is more likely to be infected with the disease. At present, its impact on kidney transplant recipients is unclear. This article reports the clinical features and therapeutic course of novel coronavirus infection in a patient after renal transplantation. A 37-year-old female patient who received a kidney transplant 6 months before was diagnosed with novel coronavirus pneumonia. The patient’s symptoms (such as fever, chills, dry cough, muscle aches), laboratory tests (such as decreased white blood cell count, elevated liver enzymes and D-dimer, positive viral nucleic acid test), and chest CT (multiple left lower lung plaque ground glass shadow) were similar to those of non-transplanted novel coronavirus pneumonia patients. In terms of treatment, because the immunity of kidney transplant recipients has been suppressed for a long time, it is a very common strategy to suspend the use of immunosuppressive agents. Therefore, the patient immediately discontinued the immunosuppressive agent after admission, so that she could restore immunity against infection in a short time. At the same time, the use of glucocorticoids was also very important. Its immunosuppressive and anti-inflammatory effects played a large role in the treatment process.In addition, prophylactic antibiotics was needed, and nephrotoxic drugs should be used with caution. Finally, following discounting the use of immunosuppressant and a low-dose glucocorticoid-based treatment regimen, COVID-19 in this renal transplant recipient was successfully cured. The cure of this case was of great significance, and this adjuvant nonspecific antiviral therapy could provide a template for the treatment of other such patients.     

蛋白A免疫吸附治疗高致敏肾移植受者1例报告并文献复习

目的肾脏移植的致敏性是目前临床面临的一大难题,高致敏受者接受移植的机会大大减少,我们对1例高致敏受者肾移植围手术期采用蛋白A免疫吸附疗法配合免疫抑制治疗,观察其临床效果,结合文献评估疗效.方法受者采用蛋白A免疫吸附成功进行肾移植病例,同时回顾通过国内外文献检索得到的蛋白A免疫吸附治疗肾移植高致敏受者的病例.结果结合我们目前的病例,分析已被报道的66例(国内30例,国外36例)蛋白A免疫吸附治疗肾移植高致敏受者的病例,发现大部分患者采用了蛋白A免疫吸附可以明显降低IgG、IgM、IgA等,PRA从术前30%～100%降低到术后30%以下,65例成功进行了肾移植.结论 Protein A免疫吸附可以清除体内免疫球蛋白疗效明显,结合免疫抑制治疗使肾移植高致敏受者成功接受肾移植,提高移植肾远期存活率.     

多原发肿瘤含肾神经鞘瘤1例报道并文献复习

多原发肿瘤并不常见,其中包含肾神经鞘瘤者更为罕见。本研究报道1例合并肾神经鞘瘤的多原发肿瘤的诊治。患者为女性,曾患左卵巢皮样囊肿、右后纵隔神经鞘瘤、左前臂神经鞘瘤、甲状腺乳头状癌,并行手术治疗。1个月前体检发现左肾肿物伴左肾上腺肿物,于北京大学第三医院行后腹腔镜左肾上腺结节切除术、左肾部分切除术。手术顺利完成,无中转开放,术中动脉阻断时间18 min,出血20 mL。病理检查示左侧肾富于细胞型神经鞘瘤伴局灶囊性变,肿瘤直径约3 cm。免疫组织化学S-100（+）,Ki-67（15%+）。短期随访无复发。本研究患者神经鞘瘤为异时性,分别予手术切除,其肾神经鞘瘤为良性,行腹腔镜肾部分切除术不但创伤小、恢复快,更重要的是可以最大限度的保留肾组织,避免术前病理的不确定性而行根治性肾切除术。     

普乐可复在肾移植患者体内的药代动力学

目的　了解肾移植患者体内普乐可复 (FK5 0 6 )药代动力学特征 ,为临床制定个体化用药方案提供依据 .方法　采用微粒子酶免分析仪测定用药前后不同时间全血中 FK5 0 6浓度 ,以 3P97药动学程序拟合求算 FK5 0 6药动学参数 .结果　在患者 po FK5 0 6 (9m g/ 12 h)达稳定态后 FK5 0 6在体内处置为一室开放模型 ,药动力学参数 Tmax,ρmax,T1 /2 ke,AUC分别为 1.2 h,75 .3mg· L- 1 ,3.9h和 5 2 6 .6 mg· h· L- 1 ,全血浓度波动差值为 6 3.4mg· L- 1 .结论　为降低 FK5 0 6全血浓度波动范围 ,采用 8h一次 po FK5 0 6更为适宜 ,同时应加强 FK5 0 6血药浓度监测 ,确保用药安全和有效     

妊娠高血压重度子痫前期及子痫患者终止妊娠时机及方式的探讨

目的：探讨妊娠高血压重度子痫前期、子痫患者终止妊娠的时机和方式对母婴的影响。方法：回顾性分析55例妊娠高血压重度子痫前期、子痫患者在不同孕周及采取不同方法终止妊娠对母婴结局的影响。结果：妊娠高血压重度子痫前期、子痫患者55例入院后经药物治疗分别选择适当时机及分娩方式终止妊娠,无1例孕产妇死亡,新生儿窒息率33．87％。结论：治疗妊娠高血压重度子痫前期、子痫患者适时终止妊娠是极重要的手段,剖宫产已成为主要措施。     

重症尿毒症肺1例并文献复习

尿毒症肺(uremic lung)是尿毒症患者因代谢产物潴留引起的继发性、非感染性的肺部损害,也称为尿毒症肺水肿(uremic pulmonary edema)或尿毒症肺炎(uremic pneumoni-tis).它是由病理学家首先描述的,最早的影像学记载是1934年由Roubier和Planchu首次报道的[1].     

免疫吸附在高致敏肾移植受者中的应用

目的 探讨蛋白A免疫吸附(IA)治疗在预防高致敏肾移植受者急性排斥反应中的效果和安全性.方法 回顾性分析2008年3月至2009年10月首都医科大学附属北京朝阳医院收治的12例群体反应性抗体(PRA)高的肾移植患者在术前应用IA治疗的临床资料.比较治疗前后血免疫球蛋白IgG、IgM、IgA及PRA水平.观察患者术后急性排斥反应发生情况及不良反应.结果 12例患者IA治疗次数为3～8次.治疗后PRA Ⅰ和Ⅱ类抗体均较治疗前明显下降[14%(4%,27%)比86%(73%,98%),6%(0,23%)比68%(34%,88%),均P＜0.01];血清总IgG水平较治疗前明显下降[(550±341)g/L比(1301±393)g/L,P＜0.01];IgA和IgM也较治疗前降低[(144±78)g/L比(185±93)g/L,(103±48)g/L比(131±66)g/L,P＜0.01].5例患者在术后发生了急性排斥反应,给予抗胸腺细胞球蛋白(ATG)或联合IA(2例)治疗后均逆转.术后6个月内,1例患者发生烟曲霉菌肺炎,2例出现卡氏肺囊虫肺炎,均治愈.结论 IA治疗可降低高致敏患者体内预存抗体水平.辅以诱导治疗对预防和减轻肾移植术后排斥反应疗效确切.