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目的:分析19例肾移植术后移植肾带功死亡原因,为临床防治移植肾带功死亡提供参考。 方法:回顾性分析19例移植肾带功死亡者的临床资料。 结果:感染死亡12例,其中肺部感染10例(5例混合感染、2例单纯感染、3例不明原因的肺部感染),术后尿漏引起菌血症2例(均为混合感染);心脑血管意外死亡5例,均为50岁以上(其中脑出血2例、急性左心衰2例、DIC 1例);恶性肿瘤死亡2例(均为淋巴瘤)。 结论:感染是移植肾带功死亡的最常见原因,与术后免疫状态低下和手术并发症有关,其中肺部感染最重要,移植后肺间质纤维化可能与感染或某些免疫抑制剂有关;心脑血管意外多发生于老年人,术前术后多有难治性高血压及心功能不全;恶性肿瘤的发生与术后免疫力低下有关。防止肾移植术后带功死亡的关键在于预防,对于引起术后带功死亡原因要早发现、早诊断、早治疗,合理调整免疫抑制剂。
OBJECTIVE: To analyze the causes of death of kidney transplantation after renal transplantation in 19 cases and provide references for clinical prevention and treatment of death of kidney transplantation. Methods: A retrospective analysis of 19 cases of renal transplant patients died of clinical data. Results: There were 12 deaths from infection, including 10 pulmonary infections (5 mixed infections, 2 simple infections and 3 unexplained lung infections). Postoperative urine leakage caused bacteremia in 2 patients (all were mixed infection) ; 5 cases of cardiovascular and cerebrovascular accidental death, all of which were over 50 years old (including 2 cases of intracerebral hemorrhage, 2 cases of acute left heart failure, 1 case of DIC); 2 cases of malignant tumor death (all lymphoma). CONCLUSIONS: Infection is the most common cause of death from kidney transplantation and is associated with postoperative immunocompromisedness and surgical complications. Pulmonary infection is most important. Pulmonary interstitial fibrosis after transplantation may be related to infection or certain immunosuppressive agents ; Cardiovascular and cerebrovascular accidents occurred in the elderly, preoperative and postoperative refractory hypertension and cardiac insufficiency; the occurrence of malignant tumors and postoperative immunity is related to low. The key to preventing the death of patients with kidney function after kidney transplantation is prevention, which should be detected early, early diagnosed and treated as soon as possible, and the immunosuppressive agents should be reasonably adjusted.