老年肾移植的临床特点及治疗

目的探讨老年(≥60岁)肾移植患者的临床特点及治疗对策。方法回顾分析了自2001年9月~2007年11月我院施行的62例60岁以上肾脏移植患者的临床资料,对其原发疾病、手术的安全性、术前准备、术中及术后并发症的处理等进行分析、总结。结果本组病人的原发疾病中以高血压肾病引起的尿毒症比例较高(24/62);老年患者心脏储备功能差,心胸比均超过0.58,术后容易出现心衰(10/62);所有病例均有不同程度动脉粥样硬化,给手术中血管吻合带来一定难度;高龄患者免疫力相对较低,急性排斥发生率较低(4/62),但感染的发生率相对较高(21/62);充分的术前准备,早期及时处理并发症仍能获得较高成功率(57/62)。结论高龄患者是肾脏移植的不利条件,但并不是禁忌证;重视心脏储备功能差、免疫力相对较低等临床特点,积极预防和及时处理并发症,是提高移植成功率的关键措施之一。

CLINICAL CHARACTERISTICS OF RENAL TRANSPLANTATION IN ELD PATIENT AND THERAPEUTIC STRATEGY

Objective To study the clinical features and therapy strategy of elderly renal transplantation in order to improve their outcome. Methods Retrospectively analyze the clinical data of 62 cases of kidney transplantation patients over the age of 60 from September 2001 to November 2007 implemented in our hospital about their primary disease, the safety of surgery, preoperative preparation, intraoperative and postoperative complication disease treatment. Results This group of patients with primary disease of hypertension renopathy caused a higher proportion of uremia （24/62） ; in eld patients with poor cardiac reserve function, cardiothoracic ratio more than 0.58, postoperative prone to heart failure （10/62） ; All cases have different degrees of atherosclerosis which brought about a certain degree of difficulty to vascular anastomosis surgery ; eld patients is relatively low immunity, low incidence of acute rejection （4 / 62） ,but the incidence of infection is relatively high （21/62） ; adequate preoperative preparation,early and timely treatment of complications can still get a higher success rate （57/62）. Conclusion Eld patients with kidney transplantation are the adverse conditions, but not contraindieation; attention to poor cardiac functional reserve, relatively low immunity, clinical features, prevention and timely treatment of complications, etc. are the key to improve transplantation success rate.