Coping with uncertainty and ambivalence while awaiting a cadaveric renal transplant

A qualitative approach was used to identify concerns of candidates awaiting cadaveric renal transplant and to identify coping strategies used during the wait. Patients who were within 10 days postrenal transplant were interviewed and asked to recall their concerns during the wait. Two major concerns were identified through the analysis--uncertainty and ambivalence. The problems are presented with supporting vignettes and strategies used by the subjects to cope with the problem.     

Plasma zinc content in patients with chronic renal insufficiency before and after kidney transplantation

Zinc content in blood plasma was measured in patients with chronic renal failure (CRF) before and after kidney transplantation by atomic-absorption spectrophotometry. Plasma zinc was revealed to be lowered. However, routine intake of vitamin A by the patients led to an elevation in zinc content. Hemodialysis did not alter blood plasma zinc concentration. It was noted that during the postoperative period, the zinc level returned to normal. Patients with CRF show marked disturbances of taste sensitivity, which are manifested in the increased threshold of taste sensitivity and perversion of taste sensations.     

亲属活体供肾与同期尸体肾移植40例比较

背景:近年亲属活体问肾移植数量明显增加,供肾者的安全性及亲属活体供肾的移植质量受到日益重视.目的:总结40例亲属活体供肾移植的临床经验,评价其效果及安全性.方法:广西中医学院附属瑞康医院移植泌尿外科在2007-06/2008-08共完成亲属活体供肾移植40例,回顾分析供、受者相关的临床资料.同期随机抽取尸肾移植40例,将亲属活体间肾移植受者与尸肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率、外科相关并发症发生率等方面进行比较.结果:所有供者手术时间仅1.0～2.0 h,供肾热缺血时间15 S左右,冷缺血时间1.0～2.0 h,围手术期间未发生外科及内科并发症.受者术后肾功能恢复快,前3 d尿量500～1 000 mL/h,1周左右血肌酐水平均可降至正常.随访至今,所有供、受者均正常生存,移植肾功能均保持在正常范围.活体肾移植受者在血肌酐水平恢复正常时间、急性排斥反应发生率、肾功能延迟恢复发生率等方面均显著低于尸肾移植.开放切取供肾手术时间短、热缺血时间短,在手术安全性方面也有一定的优势.     

预致敏受者尸体肾移植术后的急性排斥反应

目的：预致敏肾移植受者的增加已是目前肾移植成功的重大影响因素。观察人类白细胞抗原氨基酸残基配型及新型免疫抑制剂治疗方案对预致敏患者肾移植术后急性排斥反应的治疗效应，寻找提高移植物存活率的最佳方案。方法：选择2003—01／2005—08在首都医科大学附属北京友谊医院行肾移植手术的患者396例，患者均知情同意。分组：①预致敏组（n=32）：即术前致敏患者。采用诱导治疗（抗淋巴细胞球蛋白100mg／d，3～7d）＋三联免疫抑制剂维持治疗方案（他克莫司＋霉酚酸酯＋激素）。②对照组（n=364）：未致敏患者。采用三联免疫抑制剂维持用药方案。比较两组患者肾移植术后6个月内急性排斥反应发生率、移植肾功能延迟恢复发生率及移植肾，患者1年存活率，同时分析人类白细胞抗原氨基酸残基配型对移植肾急性排斥反应的影响。结果：396例患者全部进入结果分析。①两组患者肾移植术后急性排斥反应发生率差异无显著性意义（P〉0．05）。预致敏组患者移植肾功能延迟恢复发生率显著高于对照组（P〈0．01）。②两组患者1年存活率差异无显著性意义（P〉0．05）。预致敏组患者1年移植肾存活率低于对照组（P〈0．05），如果去除患者死亡因素的影响，两组患者1年移植肾存活率差异无显著性意义（P〉0．05）。③预致敏组患者人类白细胞抗原氨基酸残基相配率高于对照组（P〈0．05）。预致敏组中氨基酸残基配型3-4错配患者的急性排斥反应发生率显著高于0-2错配患者（P〈0．01），高度致敏患者（移植术前群体反应抗体〉50％）急性排斥反应发生率显著高于低度致敏患者（群体反应抗体10％-20％）（P〈0．01）。结论：供受者之间良好的人类白细胞抗原氨基酸残基分型及采用新型免疫抑制药物治疗方案，对预防及减轻致敏患者移植术后急性排斥反应疗效确切，并可以缩短致敏患者等待移植手术的时间。     

肾移植术后患者的营养状况评价

目的:调查肾移植术后患者的营养状况,探寻合理的临床营养治疗方案。方法:抽取2002-10/2006-09于江苏省中医院住院的肾移植术后1个月患者40例,患者均知情同意,配合各种测量、检查。调查内容:①膳食调查:采用饮食称重法。蛋白质应为总热量的30%～35%,碳水化合物应为50%～60%,脂肪应为10%～15%。②人体测量:包括身高、体质量、三头肌皮褶厚度、上臂围、上臂肌围。③生化实验室检查:包括血浆白蛋白、血胆固醇、血糖、血尿酸、血钾、血钠、总淋巴细胞计数。结果:40例患者全部进入结果分析,无脱落。①肾移植术后患者膳食结构不合理,其中脂肪(38%)和蛋白质(17%)摄入量超标,碳水化合物(45%)摄入不足。②40例患者中高血糖者9例(占22.5%),胆固醇、三酰甘油升高者28例(占70%),血尿酸升高者18例(占45%)。结论:通过营养评价可为改善肾移植术后患者营养状况提供依据,指导患者平衡膳食,维持理想的营养状况。     

Stressors in renal transplant recipients at six weeks after transplant

The purpose of this study is to identify stressors that renal transplant recipients report experiencing 6 weeks posttransplantation and compare them with stressors reported by Hayward et al. (1989). The sample consists of 48 adult renal transplant recipients. Stressors are measured by the Kidney Transplant Recipient Stress Scale. The most stressful item identified is the possibility of repeated hospitalizations, different from the Hayward Study in which possibility of rejection was the most frequently reported stressor. Nurses can use this information to better understand the stressors related to the renal transplant experience and to then develop appropriate interventions that can enhance clients' self-care actions.