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背景:多尿期肾移植患者围手术期的水及糖电解质的平衡与及时的营养支持治疗对移植肾脏的功能恢复至关重要。目的:探讨肾移植围手术期的水电解质平衡维护及营养支持的方法和时机。设计、时间及地点:回顾性临床分析,于2003-06/2007-06在解放军第四军医大学西京医院泌尿外科完成。对象:接受同种异体肾移植的慢性肾功能衰竭患者96例,男59例,女37例,年龄17~67岁,平均35.7岁。方法:以移植肾动、静脉血流开放时间为分界点,总结患者围手术期的生理特点。术前维持患者生命体征平稳,手术开始时即开始匀速输血,移植动、静脉血管开放前积极补充清蛋白,开始排尿且尿量大于每小时100mL,即开始循环补循环补液配方,简化的肾移植术后多尿期输液。主要观察指标:术后1d检测患者血肌酐、尿素氮、电解质、血糖和尿液。结果:术后最初12~16h,患者尿量在260~1200mL/h,平均520mL/h。术后测血常规显示,8例出现轻度低钠血症,占8.3%,3例出现高钾,于肾功能恢复后正常,1例发生低钾,补钾治疗及肾功能恢复后正常。血氯无异常变化。21例血糖高于正常,占21.9%,激素冲击结束后恢复正常。其他患者电解质、血糖均正常,无低钙、镁者。尿比重均在1.010~1.015之间。结论:移植肾动、静脉血流开放前的输液应以胶体如浓缩红细胞、血浆及清蛋白为主,多尿期应规律及时的补充水及电解质,适当的营养支持有助于吻合口愈合,尿量稳定后应预防代谢性酸中毒。
BACKGROUND: The perioperative balance of water and sugar electrolytes and timely nutritional support for patients with polyuria in renal transplantation are crucial for the functional recovery of transplanted kidneys. Objective: To discuss the methods and timing of perioperative water and electrolyte balance maintenance and nutritional support during renal transplantation. DESIGN, TIME AND SETTING: The retrospective clinical analysis was performed at the Department of Urology, Xijing Hospital, Fourth Military Medical University of Chinese People’s Liberation Army from June 2003 to June 2007. PARTICIPANTS: A total of 96 patients with chronic renal failure who underwent allogeneic kidney transplantation, 59 males and 37 females, aged 17-67 years (average 35.7 years). Methods: The graft kidney and venous flow open time as the cut-off point, summarize the perioperative physiological characteristics of patients. Preoperative maintenance of vital signs in patients with stable, the beginning of the operation began to uniform blood transfusion, transplants, veins open before the active replenishment of albumin, urination and urine output is greater than 100mL per hour, that is, the cycle began circulating fluid replacement formula, simplified renal transplantation Postoperative polyuria infusion. MAIN OUTCOME MEASURES: Serum creatinine, urea nitrogen, electrolytes, blood glucose and urine were measured at 1 day after operation. Results: During the first 12 ~ 16h after operation, the urine output of patients was 260 ~ 1200mL / h with an average of 520mL / h. Postoperative blood tests showed mild hyponatremia in 8 cases (8.3%), high potassium in 3 cases, normal after renal function recovery, hypokalemia in 1 case, normal potassium administration and renal function recovery. No abnormal changes in blood chlorine. 21 cases of hyperglycemia than normal, accounting for 21.9%, hormones returned to normal after the impact. Other patients electrolytes, blood glucose were normal, no low calcium, magnesium who. Urine specific gravity are between 1.010 ~ 1.015. CONCLUSIONS: Transfusion of arterial and venous blood flow before transplantation should be colloid, such as concentrated red blood cells, plasma and albumin, polyuria should be regular and timely replacement of water and electrolytes, appropriate nutrition support anastomotic healing, Stable urine output should prevent metabolic acidosis.