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。     

同种异体原位心脏移植3例围手术期护理体会

2005年以来，我们共成功施行同种异体原位心脏移植术3例，未发生严重并发症。现将围手术期护理体会报告如下。     

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.     

肝移植患者围手术期的临床护理

肝移植手术复杂，病情变化波动大，手术时间长，创伤大，因此，围手术期护理非常重要。现将我院2005年11月-2006年10月6例同种异体原位肝移植手术的围手术期护理体会介绍如下。     

同种异体肾移植15例报告

报道１５例施行同种异体肾移植病人，原发病为慢性肾小球肾炎１２例，药物性肾 病、盆腔异位肾损伤及多囊肾各１例。术后免疫抑制药物采用环了包素Ａ、硫唑嘌及强的松三联用药，出现急性排异时应用甲基强的松龙冲击疗法，移植肾功能可逆转。     

1例自体肾移植患者围手术期的护理

肾移植是治疗终末期肾功能不全最有效的方法之一。2009年9月,我科为1例双侧肾动脉狭窄、伴高血压的患者成功实施了自体肾移植手术,目前患者恢复良好,已康复出院。现将围手术期护理报告如下。     

终末期肾病同种异体肾移植术206例治疗体会

自1997年7月以来,我们对206例终末期肾病（尿毒症期）患者行同种异体肾移植术,效果满意。现报告如下。     

同种异体输血及自体血回输在脊柱手术围术期的预测因素

目的筛选成年脊柱内固定术患者围术期同种异体RBC输血和术中有效自体血回输的预测因素。方法对2011年9月至2012年12月253例脊柱内固定术患者的围术期相关因素进行多因素Logistic回归分析,以期发现围术期异体RBC输血和术中自体血回输的相关预测因素。结果 253例患者中,32.0%患者围术期接受异体RBC输血(平均3.1 U),其中58.0%接受术中输血,70.0%异体RBC量用于手术当天。69.6%患者使用自体血回收技术,其中仅68.8%进行自体血回输(平均回输719 ml)。Logistic回归分析显示:患者年龄、术前血红蛋白(Hb)值、内固定节段≥4节、椎弓根钉≥6枚、椎体融合节段≥3节和椎板切除减压是围术期异体输血的独立预测因素;手术入路、内固定节段数≥4节、椎弓根钉数≥6枚、融合椎体数≥3节和术中椎板切除减压节段≥2节是自体血回输的独立预测因素。结论高龄、术前低Hb值、多节段的椎体融合和内固定、多椎弓根钉的固定、椎板切除减压对脊柱内固定术患者的围术期异体输血具有预测作用。对手术选择前路、内固定节段数≥4节、椎弓根钉数≥6枚、融合椎体数≥3节和术中椎板切除减压节段≥2节的患者应积极使用自体血回输技术。     

老年患者肾移植的围手术期治疗

目的 探讨老年患者肾移植的临床特点和围手术期治疗要点，提高老年肾移植患者人／肾存活率。方法 对27例老年肾移植患者的临床资料进行分析总结。结果 21例发生各类并发症，主要有感染和药物性肝功能损害等，治疗后19例恢复正常，治愈率90．5％。1、3年人／肾存活例数分别为25／25，23／21；存活率分别为92．6％／92．6％；85．2％／77．8％。结论 术前全身状态差，术后并发症多时老年肾移植患者的主要临床特点，也是制约其人／肾存活率的主要因素；完善围手术期治疗措施，及时准确检测，合理调整用药是提高老年肾移植患者人／肾长期存活的重要保证。     

骁悉用于同种异体肾移植62例报告

骁悉 (MMF)为一新型免疫抑制剂。 1998年以来 ,我们将其用于同种异体肾移植术后患者 ,效果满意。临床资料 :本组男 5 1例 ,女 11例 ,年龄 11～ 6 5岁 ,平均4 0 .5岁。随机分为两组 ,MMF组 32例 ,对照组 30例 ,均行同种异体肾移植术。供者与受者血型相同 ,术前均行 HL A配型 ,测定 HL A- A、B、DR等 6个位点 ,所有患者均达到 3个位点以上。移植肾热缺血时间 <10分钟 ,冷缺血时间 <6小时。两组术后均三联用药 ,MMF组用 MMF、CSA及 Pred,MMF0 .75 g,每日 2次 ;CSA起始剂量 4 mg/ kg,术后第 3天用量为 5 .5 mg/ kg,后根据 CSA血浓…     

同种异基因骨髓移植5例报告

我们近年用同种异基因骨髓移植（ａｌｌｏ－ＢＭＴ）治疗急性放射病和白血病５例。其中２例为事故性急性放射病，由ＨＬＡ半相合的供体供髓，１例骨髓移植成功后存活９０天，后因两肺弥漫性纤维化而死于呼吸衰竭。３例白血病患者移植后白血病缓解，均持续无病生存。采用小剂量环胞霉素Ａ（ＣＳＡ）＋氨甲喋呤（ＭＴＸ）预防急性移植物抗宿主病（ａＧＶＨＤ），结果４例骨髓移植成功者其ａＧＶＨＤ均控制在Ⅱ°以下，并经用甲基强的松龙治疗后症状控制。     

Acute Kidney Injury in the Modern Era of Allogeneic Hematopoietic Stem Cell Transplantation

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Successful Treatment of Fibrosing Cholestatic Hepatitis Following Kidney Transplantation With Allogeneic Hematopoietic Stem Cell Transplantation: A Case Report

Fibrosing cholestatic hepatitis (FCH) is an uncommon complication of renal transplantation and usually associated with hepatitis B and C viral infection. Without treatment, the prognosis is usually fatal within weeks of onset. There was rarely report with successful treatment intervention.This case report describes a uremic patient with HCV infection who developed a fatal form of FCH after kidney transplantation. This is the first reported successful case with allogeneic hematopoietic stem cell transplantation (AHSCT) without ablative conditioning.A dramatic virologic and clinical improvement was observed in this post-transplantation patient. But no adverse events related to AHSCT were observed. The patient returned to work full-time at 10 months of hospitalization and is still in good health by now. Serum HCV RNA gradually decreased from 2.5 × 10⁶ Copies/mL at day 1 to 3.2 × 10⁴ Copies/mL at day 98 and became negative (<400 Copies/mL) at day 126 of hospitalization and remains negative at the last available assessment.Our report suggests that allogeneic HSCT may have a therapeutic role in FCH.     

Hyperthyroidism After Allogeneic Hematopoietic Stem Cell Transplantation: A Report of Four Cases

Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for many hematological disorders, primary immunodeficiencies, and metabolic disorders. Thyroid dysfunction is one of the frequently seen complications of HSCT. However, hyperthyroidism due to Graves’ disease, autoimmune thyroiditis, and thyrotoxicosis are rare. Herein, we report a series of 4 patients who were euthyroid before HSCT but developed hyperthyroidism (3 of them developed autoimmune thyroid disease) after transplantation.     

急性血吸虫病180例患者的临床护理观察

目的确保急性血吸虫病患者在入院后得到及时有效的治疗和护理,尽早恢复健康。方法对180例急性血吸虫病患者进行标本兼治,做好心理护理和发热的护理,提高免疫力,加强用药观察。结果 180例患者均100%痊愈出院。结论急性血吸虫病首选吡喹酮杀虫治疗,同时对症处理和心理护理,能促进患者早日康复。     

老年患者眼部带状疱疹的观察与护理

目的：探讨老年患者眼部带状疱疹治疗的临床观察与护理。方法：对42例老年带状疱疹的综合治疗和精心护理进行分析总结。结果：本组患者均恢复生活自理能力,无1例复发。结论：针对患者的特点给予综合治疗、密切地临床观察和护理是治疗成功的关健。     

Second Allogeneic Bone Marrow Transplantation after Myeloablative Conditioning Analysis of 43 Cases from Single Institution

Between March 1984 and December 1999, a total of 43 second related allogeneic BMT procedures after myeloablative conditioning were carried out in our institution, 37 following allogeneic, and 6 following autologous BMT. Thirty one patients were males (72%). At 1st BMT (BMT<PRE>1</PRE>), median age was 11.5 years (range, 0.16-45 years). BMT<PRE>1</PRE> was carried out for the diagnosis of AML in 13 patients (30%), SAA in nine (21%), ALL in six (14%), CML in six (14%), immunodeficiency in three (7%), NHL in two, β-thal in two, HD in one, Red cell aplasia in one. HLA matching status for allogeneic BMT<PRE>1</PRE> was full match in 33, one antigen mismatch in two and haplo identical in two patients. Median age at the 2nd BMT (BMT<PRE>2</PRE>) was 14 years (range, 0.41-46.7 years). Indications for BMT<PRE>2</PRE> were recurrent hematologic neoplasm in 23 patients (53%), primary graft failure in 12 (28%) and late graft failure in 8 (19%). Median time from BMT<PRE>1</PRE> to recurrence of hematologic neoplasm or late graft failure was 10 months (range, 2.5- 88 months). Median BMT<PRE>1</PRE> to BMT<PRE>2</PRE> interval was 13 months (range, 1-107 months). For BMT<PRE>2</PRE>, the same donor was used in 29 patients, while 14 patients had alternate related donor (12 full match, 1-one Ag mismatch, 1 haplo identical). A different conditioning regimen was used in the majority of the patients (39, 91%). Radiation containing conditioning regimen were used mostly for patients previously conditioned with chemotherapy only for BMT<PRE>1</PRE> and chemotherapy conditioning±ATG for those who received radiation containing conditioning at BMT<PRE>1</PRE>. Bone marrow was the stem cell source for all patients at BMT<PRE>2</PRE> and all except three autologous peripheral stem cell transplantation patient at BMT<PRE>1</PRE>. Significant organ toxicity leading to procedure related death in 13 patients (30%) was observed after BMT<PRE>2</PRE>. At a median follow up of 36 months after BMT<PRE>2</PRE>, 22 patients (51%) are alive (20 free of disease, 2 with recurrent disease) with overall median survival of 47.5 (SD±9) months. Univariate analysis of relevant clinical factors identified the following variables as the only statistically significant favorable prognostic factors for overall survival: BMT<PRE>1</PRE>-BMT<PRE>2</PRE> interval of ≥6 months (P=0.0007) and age at BMT<PRE>2</PRE> ≤10 years (P=0.041). The nature of underlying disease (neoplastic or non-neoplastic) was not statistically significant (P=0.23). There was no statistically significant difference in survival outcome of BMT<PRE>2</PRE> using same donor vs. alternate related donor (P=0.51). Due to the relatively limited sample size, multivariate analysis was not attempted. This single institution study suggests that second allogeneic BMT after myeloblative conditioning has an acceptable treatment related morbidity/mortality and favorable outcome if performed at age ≤10 years and with an interval of ≥6 months after the first BMT. Additionally same donor can successfully be used for the second transplant with similar survival outcome to alternate donor.     

Kidney Disease Symptoms before and after Kidney Transplantation

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ABO血型不合同胞间异基因外周血干细胞移植后纯红细胞再生障碍性贫血3例报告

目的：探讨ABO血型不合异基因外周血干细胞移植后纯红细胞再生障碍性贫血(PRCA)的治疗。方法：报道3例病例并进行文献复习。结果：3例HLA配型完全相合、ABO血型主要不合的患者进行同胞间异基因外周血干细胞移植获得成功,但移植后均出现PRCA。1例经大剂量糖皮质激素联合大剂量免疫球蛋白治疗,2例经大剂量糖皮质激素联合血浆置换治疗后血型均转为供者血型,血红蛋白逐渐恢复正常。结论：大剂量糖皮质激素联合血浆置换或大剂量免疫球蛋白是治疗ABO血型不合异基因外周血干细胞移植后PRCA的有效方法。