围手术期处理对低龄、低体质量儿童肾移植效果的影响

目的 探讨完善的围手术期处理对低龄、低体质量（＜ 30 kg）尿毒症患儿肾移植术后效果的影响.方法 2008年12月至2013年11月期间在郑州大学第一附属医院肾移植科接受同种异体肾移植术的16例低体质量尿毒症患儿纳入研究.术前给予患儿充分透析,根据其具体情况制定个体化透析方案,使患儿术前体质量接近干体质量;纠正心肺功能,当患儿心肺功能达标后行肾移植术.术后规律随访患儿身高、体质量、肝肾功能、血尿常规、电解质和他克莫司浓度.结果 1例患儿手术过程中出现心脏骤停,经胸外心脏按压、强心、补充血容量等治疗后恢复心跳;其余15例患儿均顺利完成肾移植手术.围手术期1例患儿出现急性排斥反应,2例出现肺部感染,2例出现肝功能异常,调整免疫抑制剂及对症治疗,16例患儿血肌酐均降至正常并顺利出院.术后均规律随访,平均随访时间（13±7）个月,人/肾存活率为100％.结论 低龄、低体质量尿毒症患儿入院后应严格完善术前检查并充分透析治疗,加强营养,纠正贫血,改善患儿心肺功能,彻底治疗合并症后再行肾移植术,可取得满意的移植效果.

Effects of perioperative management on pediatric kidney transplantation in children with low weight

Objective To investigate the effects of perfect perioperative management on pediatric kidney transplantation in children with low body weight （less than 30 kg）.Methods Sixteen pediatric uremia patients with low weight who received allogeneic renal transplantation in the First Affiliated Hospital of Zhengzhou University from August 2011 to November 2012 were enrolled in the study.In order to make the weight of the children close to dry weight,sufficient preoperative hemodialysis was performed.At the same time,cardiopulmonary function was corrected so that renal transplantation might be possible.Recipients＇ height,weight,liver and kidney function,urine routine,electrolytes and tacrolimus concentration wene followed up after surgery.Results One podiatric renal transplant recipient experienced cardiac arrest and recovered after cardiac rehydration therapy.The remaining 15 cases successfully completed kidney transplantation.One recipient developed acute rejection,2 recipients appeared pulmonary infection and 2 recipients appeared abnormal liver function during perioperative period,and their the serum creatinine all dropped to normal after adjusting immunosuppressants and symptomatic treatment.Conclusions Checking strictly,giving sufficient hemodialysis treatment,improving heart and lung function and excluding surgical contraindications should be taken for the children with low weight before transplantation.