肾移植术后肾功能延迟恢复的诊断与治疗(附25例报告).doc

肾移植术后肾功能延迟恢复的诊断与治疗（附25例报告） 　　作者：文海涛　赖彦华　何猛　周大庆　孙煦勇　刘尚文　李文刚　　作者单位： 530021 广西南宁，解放军第303医院泌尿外科 　　【摘要】 目的 研究和探讨肾移植术后肾功能延迟恢复的发病机制，提高移植肾功能的有效恢复率。方法 对25例肾移植术后无尿，临床完全排除排斥反应，而移植肾血液供应良好的病人进行临床观察治疗。常规三联免疫抑制药(Pred+CsA+Aza)，13例病人使用川芎嗪静脉点滴，80mg/d，连续10～15天。12例病人使用前列腺素E1静滴，100mg/d，利尿合剂每天1次。全部病人每周血透2次。每周CsA血药浓度监测1次。结果 25例病人中有11例病人于3周后肾功逐渐恢复正常，12例于4～6周后肾功能逐渐恢复正常，只有2例SCr始终保持在250～300mmol/L不降。结论 对移植肾功能延迟恢复的病人，如诊断明确、处理及时，绝大多数病人肾功能可得以恢复。 　　【关键词】 肾移植;肾小管坏死，急性;诊断;治疗学 　　Diagnosis and management of delayed graft function of renal transplantation 　　WEN Hai-tao,LAI Yan-hua,HE Meng,et al.Department of Urology,Center of Organ Transplantation,303th Hospital of PLA,Nanning 530021,China 　　【Abstract】 Objective To explore the causes of delayed graft function (DGF) after renal transplantation,and improve the efficient recovery of the graft.Methods Twenty-five patients following renal transplantation were diagnosed as DGF.All of them were anuria and excluded rejection,and the color Doppler ultrasonic showed blood supplies of the grafts were well.The immunosuppressive agent were CsA+Aza+Pred.Thirteen patients were given ligustrazine.Twelve patients were given prostaglandin E1.All of the patients received hemodialysis for two weeks.Monitor blood concentration of cyclosporin once a week.Results The renal function became within three weeks in eleven patients.The renal function became normal within four-six weeks in twelve patients.Serum creatinine (SCr) returned to 250～300mmol/L in 2 patients.Conclusion The renal function of DGF can become normal in most of patients if the diagnosis and treatment are preformed correctly and in time. 　　【Key words】 renal transplantation;renal tubular necrosis,acute;diagnosis;therapeutics 　　肾移植作为一种治疗尿毒症的有效手段，正迅速地在各地开展起来。随着肾移植手术的逐渐普及、有效免疫抑制剂的不断研制与更新，移植后的人/肾的长期存活率正在不断提高，但由于供肾的质量以及一些未知因素的影响，术后功能延迟恢复(DGF)的病例也不少。近年来我科对25例异体肾移植术后肾功能延迟恢复的病人进行了临床观察治疗，其有效恢复率达92%，兹将资料与方法报告如下。 　　1 资料与方法 　　1.1 一般资料 我科在同种异体肾移植的过程中，共观察了25例移植肾功能延迟恢复的病例。发病年龄25～45岁，男19例，女6例