肾移植术后早期死亡原因分析

目的:分析肾移植术后早期(6个月内)死亡原因,总结经验,提高和改善移植效果。方法:回顾性分析2000年1月~2005年2月施行433例尸体肾移植患者的临床资料,对其中19例术后早期死亡原因及相关因素进行探讨。结果:术后早期死亡病因包括感染7例,占36.8%;急性心力衰竭4例,占21.1%;肾破裂致失血性休克3例,占15.8%;弥漫性血管内凝血2例,占10.5%;暴发性肝功能衰竭1例、急性心肌梗死1例、肺动脉栓塞1例,各占5.3%。除暴发性肝功能衰竭患者于术后118天死亡外,其余均在术后1个月内死亡。结论:感染是肾移植术后早期死亡最常见的原因,与术后免疫抑制过度、营养不良及术后并发症等有关,其中以肺部和泌尿系感染最重要;心血管疾病是引起移植术后早期死亡的另一重要因素,尤其是高龄和糖尿病患者;肾移植早期死亡与肾功能延迟恢复(包括急性排斥反应和急性肾小管坏死)有密切关系,积极合理的治疗对预防肾移植术后早期死亡具有重要意义。

Analysis of the early postoperative mortality in renal transplantation recipients

Objective:To improve the effect of kidney transplantation.Methods:Between Jan 2000 and Feb 2005 in our hospital,433 patients received a cadaveric renal allograft and 19 patients died in the early postoperative period.The causes of death in these 19 cases were analyzed retrospectively.Results:Among these 19 cases,7 cases died of severe infection,4 died of acute heart failure,1 acute miocardial infarction,and 1 pulmonary artery embolism,3 cases renal rupture and shock and 2 DIC.Fulminant hepatic failure was diagnosed in the last one.(Conclusions:)Infection ranked first in the list of causes for death in this group of patients.Immunosuppressive treatment,hypoalimentation and surgical complications might contributed to the preposition for infections.