论文部分内容阅读
背景、目的和方法我院自1978年4月至1998年1月共作1240例次尸体肾移植术，其中术后发生移植肾功能延迟恢复（DGF）的93例（7．5％）。为了探讨肾移植术后肾功能延迟恢复的原因，减少并发症，提高存活率，我们对供肾的摘取、灌洗、术中血压问题及术后免疫抑制剂的应用进行研究。结果93例中急性肾小管坏死（ATN）71例（76％），其中热缺血时间＞10min56例（60．2％）、冷缺血时间＞24h2例（2．2％）、术中收缩血压低于13kPa（98mmHg）13例（14％）。肾动脉痉挛致血管栓塞3例（3．2％），术后CsA中毒8例（8．6％），急性排斥（AR）11例（11．8％）。81例（87．1％）在7～66d内肾功能恢复正常，8例（8．6％）摘除移植肾，4例（4．3％）死亡。结论肾移植术后肾功能延迟恢复是造成肾移植失败的原因之一。缩短热缺血时间、注意移植肾灌洗量、严格控制术中血压变化、合理的应用CsA药物是减少肾移植术后并发症和提高成功率的关键。
Background, Objectives and Methods A total of 1240 cadaveric renal allografts were performed in our hospital from April 1978 to January 1998, of which 93 (7.5%) had postoperative graft dysfunction (DGF). In order to explore the reasons for the delayed recovery of renal function after renal transplantation, reduce complications and improve survival rate, we studied the removal of kidneys, lavage, intraoperative blood pressure and postoperative immunosuppressive agents. Results Acute tubular necrosis (ATN) was found in 71 (76%) of the 93 cases, of which 56 cases (60.2%) were ischemic for more than 10 minutes and 24h (2.2%) for cold ischemia. Blood pressure was lower than 13kPa (98mmHg) in 13 cases (14%). Renal artery spasm caused vascular embolism in 3 cases (3.2%), postoperative CsA poisoning in 8 cases (8.6%), acute rejection (AR) in 11 cases (11.8%). 81 cases (87.1%) returned to normal renal function within 7 ~ 66 days, 8 cases (8.6%) removed the graft and 4 cases (4.3%) died. Conclusion Delayed recovery of renal function after kidney transplantation is one of the reasons for the failure of renal transplantation. Shorten the warm ischemia time, pay attention to the amount of renal transplant lavage, strict control of intraoperative blood pressure changes, a reasonable application of CsA drugs to reduce postoperative complications of renal transplantation and improve the success rate of the key.