CAJ | 학술논문

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.
목적 탐토완선적위수술기처리대저령、저체질량(＜ 30 kg)뇨독증환인신이식술후효과적영향.방법 2008년12월지2013년11월기간재정주대학제일부속의원신이식과접수동충이체신이식술적16례저체질량뇨독증환인납입연구.술전급여환인충분투석,근거기구체정황제정개체화투석방안,사환인술전체질량접근간체질량;규정심폐공능,당환인심폐공능체표후행신이식술.술후규률수방환인신고、체질량、간신공능、혈뇨상규、전해질화타극막사농도.결과 1례환인수술과정중출현심장취정,경흉외심장안압、강심、보충혈용량등치료후회복심도;기여15례환인균순리완성신이식수술.위수술기1례환인출현급성배척반응,2례출현폐부감염,2례출현간공능이상,조정면역억제제급대증치료,16례환인혈기항균강지정상병순리출원.술후균규률수방,평균수방시간(13±7)개월,인/신존활솔위100％.결론 저령、저체질량뇨독증환인입원후응엄격완선술전검사병충분투석치료,가강영양,규정빈혈,개선환인심폐공능,철저치료합병증후재행신이식술,가취득만의적이식효과.
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.