PRA阳性受体肾移植前行二重滤过血浆置换治疗的护理

探讨肾移植术前二重滤过血浆置换疗法(double filtration plasmapheresis,DFPP)对反应性抗体百分比（percent reactive antibody,PRA)阳性的受体术后排异反应的改善程度及护理。方法 用二重血浆置换林对35例PRA阳性的受体于肾移植术前作DFPP，观察手术前后PRA的改变及排异反应，另设34例作DFP的PRA阳性受体作对照；并分析DFPP的操作及护理措施。结果 35例PRA阳性DFPP后PRA水平均降低，肾移植术后仅16％出现急性排异反应；未作DFPP的阳性受体接受肾移植术后29％出现排异反应。DFPP过程中1例一级膜发生凝血，另1例出现虚脱症状，35例均无热原反应。结论 DFPP能明显改善PRA阳性受体肾移植术后的排异反应发生率。护理上应注意血浆置换量与补浆量的平衡，避免血容量波动；维持水电解质平衡，保持血浆胶体渗透压恒定；DFPP时血流量不宜过快，且须注意肝素的合理应用。

Nursing of PRA Positive Recipients Treated by Double Filtration Plasmapheresis before Renal Transplantation

objective To explore the effects of the double filtration plasmapheresis (DFPP) on PRA positive recipients before renal transplantation. Methods Before renal transplantation 35 PRA positive recipients were treated by DFPP. The alteration of PRA in plasma and the rejection phe-nomenon of recipients were observed after renal transplantation. The operation and nursing of DF-PP were analysed. 34 PRA positive recipients not treated by DFPP were used as controls. Results The levels of PRA were decreased in 35 PRA positive recipients treated by DFPP. Acute rejec-tion was found in 16% the recipients, and in 29% of the recipients not treated by DFPP. During DFPP blood coagulation occurred in one patient on the first rank membrane of the machine, and another one collapsed. There was no pyrogenic response in 35 recipients. Conclusion DFPP can improve the rejection phenomenon in PRA positive recipients after renal transplantation. During DFPP the balance of the liquid quantity out and into the vessels of patients should be watched care-fully. Blood flow shouldn't be adjusted too fast. Blood volume, water-electrolyte balance and col-loid osmotic pressure in patients must be kept stable. Heparin ought to be applied appropriately.