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肾移植受者围手术期危急值分析与处理

隋雨荧 于立新 邓文锋 邱春燕 苗芸 刘如敏 叶桂荣

隋雨荧, 于立新, 邓文锋, 等. 肾移植受者围手术期危急值分析与处理[J]. 器官移植, 2017, 8(1): 34-39. doi: 10.3969/j.issn.1674-7445.2017.01.007
引用本文: 隋雨荧, 于立新, 邓文锋, 等. 肾移植受者围手术期危急值分析与处理[J]. 器官移植, 2017, 8(1): 34-39. doi: 10.3969/j.issn.1674-7445.2017.01.007
Sui Yuying, Yu Lixin, Deng Wenfeng, et al. Analysis and management of critical value in renal transplantation recipients during perioperative period[J]. ORGAN TRANSPLANTATION, 2017, 8(1): 34-39. doi: 10.3969/j.issn.1674-7445.2017.01.007
Citation: Sui Yuying, Yu Lixin, Deng Wenfeng, et al. Analysis and management of critical value in renal transplantation recipients during perioperative period[J]. ORGAN TRANSPLANTATION, 2017, 8(1): 34-39. doi: 10.3969/j.issn.1674-7445.2017.01.007

肾移植受者围手术期危急值分析与处理

doi: 10.3969/j.issn.1674-7445.2017.01.007
基金项目: 

国家自然科学基金 81500573

南方医科大学南方医院院长基金 2013B011

南方医科大学南方医院院级教育课题 14NJ-ZL01

详细信息
    通讯作者:

    苗芸,Email:miaoyunecho@126.com

  • 中图分类号: R617, R619+.4

Analysis and management of critical value in renal transplantation recipients during perioperative period

More Information
  • 摘要:   目的  分析并总结肾移植受者围手术期常见危急值的特点及处理方法。  方法  收集出现危急值的273例次肾移植围手术期患者的性别、年龄、危急值、原发病、出现危急值时临床诊断及相应处理等资料并进行分析。  结果与结论  肾移植受者在围手术期危急值以水、电解质和酸碱平衡紊乱最为常见,占43.2%(118/273),其中高钾血症最常见,占24.9%(68/273);出现危急值的男性比例高于女性(76.9%比23.1%),且多集中于35~54岁年龄段。对于出现高钾血症危急值患者,依次使用葡萄酸钙或氯化钙稳定心肌细胞膜、胰岛素、葡萄糖以及碳酸氢钠静脉滴注促使K+向细胞内转运、利尿药促进K+排泄,上述治疗无效则采用血液透析进行治疗。所有患者血钾均恢复正常。对出现其他危急值的患者,则针对不同情况采取个体化治疗措施。了解肾移植受者围手术期常见危急值,以及不同年龄段、不同性别的肾移植受者危急值分布的特点和原因,对临床监测和治疗有较强的指导作用。

     

  • 图  1  不同危急值项目年龄分布

    Figure  1.  Age distribution of patients with critical value in different items

    图  2  肾移植受者围手术期不同危急值项目分布

    Figure  2.  Items distribution of perioperative renal transplant recipients with critical value

    图  3  肾移植受者围手术期水、电解质失衡原因分布

    Figure  3.  Causes distribution of perioperative renal transplant recipients with metabolic disturbances and electrolyte abnormalities

    表  1  肾移植受者围手术期不同危急值项目结果统计表

    Table  1.   Critical values of perioperative renal transplant recipients (n=273)

    危急值项目 正常值参考范围 危急值范围 例次 频率(%)
    水、电解质和酸碱平衡紊乱 K+ 3.50~5.30 mmol/L ≥6.5 mmol/L 68 24.9
    ≤2.8 mmol/L 20 7.3
    Ca2+ 2.20~2.65 mmol/L ≥3.50 mmol/L 2 0.7
    ≤1.50 mmol/L 14 5.1
    Na+ 137~147 mmol/L ≥160 mmol/L 2 0.7
    ≤120 mmol/L 1 0.4
    Cl- 99~110 mmol/L ≥125 mmol/L 1 0.4
    TCO2 21~31 mmol/L ≥40 mmol/L 1 0.4
    ≤10 mmol/L 8 2.9
    pH 7.35~7.45 ≥7.55 1 0.4
    免疫抑制剂血药浓度异常 FK506 0~20 ng/mL >20 ng/mL 21 7.7
    MPA 0~15 ng/mL ≥15 ng/mL 2 0.7
    血常规异常 Hb 130~175 g/L ≥180 g/L 9 3.3
    ≤50 g/L 23 8.4
    WBC 3.50~9.50×109 /L ≥30.00×109/L 20 7.3
    ≤1.00×109/L 12 4.4
    Plt 125~350×109/L <20×109/L 19 7.0
    血糖异常 Glu 3.9~6.1 mmol/L ≥25.0 mmol/L 4 1.5
    ≤2.2 mmol/L 7 2.6
    凝血功能异常 PT 11~13 s >30 s 26 9.5
    APTT 22.7~31.8 s >70.0 s 5* -
    FK506为他克莫司;MPA为霉酚酸;Hb为血红蛋白;WBC为白细胞;Plt为血小板;Glu为血糖;PT为凝血酶原时间;APTT为活化部分凝血活酶时间;*此数据包含在PT>30 s例次中
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出版历程
  • 收稿日期:  2016-10-08
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-01-15

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