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目的 探讨尿毒症合并药物难以控制的高血压患者肾移植前切除双肾对术后血压及移植肾功能的影响。方法 42例合并顽固性高血压的尿毒症患者分成 2组 (每组 2 1例 ) ,一组先行双肾切除 ,6个月～ 1年后再行肾移植 ,另一组不切肾 ,直接施行肾移植。对比分析 2个组肾移植术后的血压及移植肾功能的恢复情况。结果 切肾组在双肾切除后 ,13例 (6 1.9% )的平均舒张压低于 90mmHg或较术前降低 10mmHg以上 ;6例 (2 8.6 % )的平均舒张压较术前降低 15 %以上 ;肾移植术后1年 ,双肾切除组血压正常者 11例 (5 2 .4% ) ,对照组血压正常者 5例 (2 3.8% ) ,两组比较 ,差异有显著性 (P <0 .0 5 ) ;移植肾 1年存活率 ,切肾组为 95 .2 % ,对照组为 81.0 % ,差异有显著性 (P <0 .0 1)。结论 存在顽固性高血压的尿毒症患者若需行肾移植 ,在明确手术指征的情况下可先行自体双肾切除术 ,这有利于肾移植术后血压的控制及移植肾功能的稳定
Objective To investigate the effect of renal biopsy before renal transplantation on postoperative blood pressure and graft function in hypertensive patients with uremia complicated with drugs. Methods 42 cases of uremia patients with refractory hypertension were divided into two groups (21 cases in each group). One group was treated with double nephrectomy and the other was performed kidney transplantation after 6 months to 1 year. Renal transplantation. The blood pressure and the recovery of renal function after renal transplantation in two groups were compared and analyzed. Results The mean diastolic blood pressure of 13 cases (6 1.9%) was lower than 90mmHg or lower than 10mmHg before the operation in 12 cases. The average diastolic pressure of 6 cases (2. 8.6%) was reduced more than 15% One year after renal transplantation, there were 11 cases (5.2%) with normal blood pressure in the two nephrectomy groups and 5 cases (2.8%) with normal blood pressure in the control group. There was significant difference between the two groups (P <0.05). The survival rate of one-year graft kidney was 95.2% in the kidney-cutting group and 81.0% in the control group, with significant difference (P0.01). Conclusions Renal transplantation in patients with refractory hypertension uremia may be performed under the condition of clear indications, which is beneficial to the control of blood pressure after renal transplantation and the stability of renal graft function