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目的探讨肾移植术后并发多脏器功能障碍综合征(MODS)的发生率、发生的高危因素,导致死亡的高危因素以及临床评价方法。方法总结48例肾移植术后出现MODS患者的临床资料,将肾移植术后发生与未发生MODS的患者进行对比,比较肾移植术后并发MODS的发生率、高危因素等;将肾移植术后并发MODS中死亡与未死亡患者进行比较,回顾性分析其死亡率、导致死亡的高危因素及临床评价方法。结果肾移植术后并发MODS患者的年龄显著大于未并发MODS患者,前者的急性排斥反应发生率明显高于后者,前者使用激素冲击、抗胸腺细胞球蛋白(ATG)或CD3-单克隆抗体(OKT3)的比例明显高于后者;肾移植术后并发MODS死亡患者的年龄显著大于未并发MODS患者、前者的急性排斥发生率明显高于后者;脏器衰竭数目分别为2、3、4个时,患者的病死率分别为40%、75%、100%;MODS评分分别为0~4、5~7、8﹥分时,患者的病死率分别为40%、57.1%、100%。结论肾移植术后发生MODS的高危因素为高龄、曾经发生过急性排斥反应、曾经使用过激素冲击、ATG、OKT3治疗等;影响MODS患者死亡的高危因素为MODS评分、衰竭脏器数目、高龄、曾经发生过急性排斥反应、曾经使用过激素冲击、ATG、OKT3治疗等,容易导致肾移植术后患者发生MODS的首发因素依次为肺部感染、移植肾功能延迟恢复、消化系统出血。
Objective To investigate the incidence of multiple organ dysfunction syndrome (MODS) after renal transplantation, the risk factors, the risk factors leading to death and clinical evaluation. Methods The clinical data of 48 MODS patients after renal transplantation were summarized and compared with those without MODS after renal transplantation. The incidence of MODS after renal transplantation and the risk factors were compared. After renal transplantation Concurrent MODS death and non-death patients were compared, the mortality was analyzed retrospectively, the risk factors leading to death and clinical evaluation methods. Results The patients with MODS after renal transplantation were significantly older than those without MODS. The incidence of acute rejection in the former group was significantly higher than that in the latter group. The former used hormone shock, anti-thymocyte globulin (ATG) or CD3-monoclonal antibody OKT3) was significantly higher than the latter; renal transplant recipients with MODS death were significantly older than patients without MODS, the former acute rejection rate was significantly higher than the latter; the number of organ failure were 2, 3, 4 The case fatality rates were 40%, 75% and 100% respectively. The MODS scores were 0-4, 5-7 and 8 respectively. The case fatality rates were 40%, 57.1% and 100% respectively. Conclusion The risk factors of MODS after renal transplantation are elderly, acute rejection, hormonal shock, ATG and OKT3 have been used. The risk factors for MODS are MODS score, number of extremity organ failure, There have been acute rejection, have used hormonal shock, ATG, OKT3 treatment, easily lead to kidney transplant patients with MODS after the onset of lung infection, delayed graft recovery, digestive bleeding.