摘要：本文通过回顾性分析 1 例肾移植术后上消化道出血的临床资料、护理及抢救措施， 总结肾移植术后上消化道出血的护理。

目的 探究心理护理对亲属活体肾移植患者的疗效.方法 收治我院收治的亲属活体肾移植手术患者155例,依照护理方法的差异将所有患者分组为常规护理组(n=77例)和心理护理组(n=78例).并对两组患者护理后身心健康状况的改善效果进行对比.结果 在生活质量的评分方面,心理护理组的评分(91.88±3.39)分显著高于常规护理组的评分(82.45±2.41)分.而在心理健康问题的改善方面,心理护理组的改善效果显著优于常规护理组,二者之间比较,差异有统计学意义(P<0.05).结论 对亲属活体肾移植手术患者实施围术期的心理护理措施,是促进患者身心健康水平提升的有效措施,有利于提高患者术后恢复期间的生活质量,临床护理效果显著.

目的 探讨网络视频健康教育在肾移植延续护理中的应用效果.方法 选取2017年1月至2018年1月于我院接受治疗的92例肾移植患者为研究对象,按照随机数表法将所有患者等分为对照组与观察组,对照组采取常规的延续护理,观察组在对照组的基础上实施网络视频健康教育.比较两组患者自我护理能力测定量表(ESCA)评分、简明健康测量量表(SF-36)评分、血肌酐(Scr)、血清尿素氮(BUN)以及半胱氨酸蛋白酶抑制剂(CysC)值;比较两组患者依从性好、并发症发生情况.结果 观察组患者ESCA评分高于对照组,差异有统计学意义(P<0.05).观察组患者SF-36评分均高于对照组,差异有统计学意义(P<0.05).观察组患者Scr、BUN、CysC较对照组低,差异有统计学意义(P<0.05).观察组患者依从性好高于对照组、并发症发生情况低于对照组,差异具有统计学意义(P<0.05).结论 网络视频健康教育应用于肾移植患者延续护理能够提高患者自我护理能力水平和生活质量,有利于临床指标的优化,提高患者治疗依从性.

目的:探讨儿童肾移植术后早期局灶节段性肾小球硬化的护理特点.方法:回顾性分析3例移植肾局灶节段性肾小球硬化患儿的资料,总结护理经验.结果:1例肾移植术后1周尿蛋白转阴,28 d后再次出尿蛋白,甲泼尼龙冲击治疗无效,血浆置换治疗后再给予静脉滴注间充质干细胞治疗,尿蛋白显著减少;术后8个月余再次出现大量尿蛋白,继续给予血浆置换后静脉滴注间充质干细胞,治疗有效,术后3年余尿蛋白转阴.1例在术后第4天即出现大量尿蛋白,即给予血浆置换,疗程中结合药物治疗,术后7个月余尿蛋白转阴并持续稳定.1例术后13 d出现尿蛋白阳性,因反复感染,术后2个月余,感染控制后行血浆置换,疗程中给予药物治疗,24 h尿蛋白定量最低可降至1.004 g.3例患儿肾功能均正常.结论:儿童移植肾局灶节段性肾小球硬化于术后出现较早,需严密观察病情,以利于早诊断、早治疗,针对不同治疗方式实施相应护理措施,并加强门诊随访,可提高移植肾存活率,促进患儿康复.

儿童供肾尤其是低龄（＜3岁）、低体质量（＜15 kg）的儿童供肾，因为肾单位不足、外科技术难度大、围手术期并发症多等原因，过去一直被认为是边缘性器官[1-3]，然而儿童供肾可以扩大供体池，缓解器官相对短缺的现状。血栓等血管并发症以及输尿管梗阻等尿路并发症，可导致移植物早期丢失；血压和体液控制不合适导致的高灌注损伤，会影响移植物的远期[2-4]存活，这些都对护理提出了更高的要求，因此，给予针对性的护理是促进患者顺利康复的重要保证。总结我院2010年2月至2015年1月开展的13例低龄儿童供体双肾整体移植的护理体会，现报道如下。

Objective To investigate the strategies of postoperative nursing of pediatric renal transplantation from donation after cardiac death.Methods A retrospective analysis of the clinical data of 15 children undergoing renal transplantation from cardiac death donors in our hospital was performed to summarize the postoperative nursing strategies.Results Due to mismatch of kidney graft volume and recipient size,the kidney grafts of two cases were placed in recipients' abdominal cavity,and the other 13 cases were placed in the iliac fossa.13 cases had the renal function recovered to normal serum creatinine within 5 days after transplantation.1 case suffered delayed graft function (DGF) and graft function was returned to normal in 20 days.1 case of 8 months child suffered DGF and graft function was returned to normal condition in 5 months.Conclusions The postoperative nursing should be performed based on the characteristics of pediatric renal transplantation from cardiac death donors.In addition to pefioperative routine nursing,fluid control and observation of postoperative abdominal distention,prevention rejection and infection,enhanced discharge health education to ensure compliance are critical to the success of pediatric renal transplantation.

This paper introduces the nursing of six patients with renal allograft rupture and hemorrhage after kidney transplantation. Close observation of the patient's condition, early detection and timely treatment, psychological nursing, nursing of acute rejection, prevention of infections and intensive care of renal allograft rupture are the key points to improve the survival rate and promote physical and mental rehabilitation.

Objective:To investigate the nursing measures of surgical treatment of urinary obstruction of graft kidney.Methods:The clinical data and nursing intervention of 16 patients with graft kidney urinary tract obstruction underwent surgical treatment were retrospectively analyzed.Results:Obstruction of the 16 cases were lifted,perioperative nursing of combination of targeted measures successfully rescued function after kidney transplantation.Conclusion:Urinary obstruction of the graft kidney is a infrequent and intractable complication which requires surgical treatment.Preoperative psychological nursing,postoperative observation on renal function and care of various channels,and thorough health education are the important guarantee for patients′ physical and psychological recovery.

目的 探讨心脏死亡供体(DCD)肾移植术后早期并发症的护理方法.方法 回顾性分析我院2007年2月至2012年6月接受DCD肾移植的71例受体(DCD组)及同期传统尸肾移植213例受体(尸肾组)的临床资料,比较2组早期并发症的情况,并总结DCD组的护理措施.结果 DCD组的移植肾功能延迟恢复(DGF)发生率高于尸肾组,其余早期并发症的发生率2组间比较均差异无统计学意义.DCD组中,有4例占5.63％发生移植肾失功,无患者死亡;尸肾组中,有4例占1.88％发生移植肾失功,有2例占0.94％死亡,1例死于脑出血,1例死于癌症晚期呼吸功能衰竭.结论 DCD可作为目前供肾来源的有效选择,加强对DGF等并发症的护理是患者平稳度过围手术期的关键。

Objective To explore the strategies and effectiveness of perioperative fluid administration during pediatric kidney transplantation.Methods In our study,we evaluated the heart function and compliance of pediatric patients preoperatively,and then formulated perioperative fluid management strategy according to children's circulation feature.The electrolytic balance was kept and complications were prevented.Results Twenty-nine out of all 48 children experienced electrolyte disturbance to different extents on day 1 postoperatively,which improved on day 2 after prompt management.There were five cases of oliguria,three cases of delayed graft function(DGF),one case of heart failure and multiple organ failure respectively.Conclusion Such nursing strategies like formulation of reasonable fluid infusion plan according to the physiological features of pediatric recipients,keeping the electrolytic balance and careful management of fluid at polyuria,oliguria and anuria,care critical for the children to live through the perioperative periods.

随着肾移植手术技术的日趋完善、成熟,术前合并各种并发症的终末期肾病患者已不再成为手术的绝对禁忌症.由于目前国内供体严重短缺,我院于2007年2月开始实施脑死亡供肾及无心跳供肾肾移植,并于2010年2月12日成功为1例慢性肾功能衰竭尿毒症期、高血压肾病患者实施了"低龄儿童脑死亡双供肾整块移植术",术后恢复顺利,现报道如下.

[目的]探讨肾移植术后移植肾功能延迟恢复(delay graft function,DGF)的临床观察与护理对策。[方法]对我科2008年9月—2010年7月332例同种异体肾移植病人密切观察,并进行规范化、个体化护理。[结果]其中发生移植肾功能延迟恢复21例,发生率6%。21例病人移植肾功能在30d～90d恢复。[结论]精细的供肾切取技术,有效的器官灌注,术中注意避免移植肾损伤结合术后密切临床观察,制定个体化护理方案,有助于减少DGF并发症的发生,有利于移植肾功能恢复。

Objective:To summarize postoperative observation and nursing interventions of polycystic kidney patients undergoing renal transplantation retained the original kidney.Methods:49 polycystic kidney patients accepted renal transplantation retained the original kidney.At the same time,we strengthened postoperative observation and nursing care.Results:All patients had no resection of the original kidney.The renal function returned to normal at 3 days to 24 days after renal transplantation.Patients'loin pain and abdominal distension were all alleviated after a long time.34 patients'original intumescent kidney volume was decreased of 15% to 30% within one month after the operations.All patients had no early acute rejection after the operations.Conclusion:To strengthen postoperative observation and nursing care of polycystic kidney patients undergoing renal transplantation retained the original kidney is the guarantee of successful operations.

目的:探讨活体小肠移植术后并发症的观察与护理方法,提高护理质量及患者术后生存率.方法:通过对1例亲属活体小肠移植患者术后并发症的观察和治疗,总结临床护理经验.结果:小肠移植术后41 d和65 d时,通过肠镜监测和病理活检证实发生急性排斥反应和巨细胞病毒感染,分别给予抗排斥、抗病毒治疗,同时做好病情观察和加强基础护理,病情得到控制.结论:采用肠镜监测和病理活检,结合临床表现,可以及早发现小肠移植术后的并发症,采取相应治疗、加强基础护理可以提高移植后患者的生存率.

目的:对肝移植术后常见心血管并发症可能的原因及护理进行总结,以提高护理质量。方法:回顾分析192例肝移植术后发生心血管并发症的护理要点。结果:高血压173例,心衰21例,心肌缺血性疾病16例。结论:心血管并发症是肝植术后严重的并发症之一,术后严密观察病情变化及时发现临床症状的改变,注意维持出入量平衡,合理的用药护理对降低术后心血管并发症的发生有重要的意义。

目的:探讨原位肝移植术后并发曲霉菌感染的护理要点。方法:回顾性分析近6 a来原位肝移植术后并发曲霉菌感染13例患者的临床资料,总结护理经验。结果:肺部感染7例,肝脏感染2例,颅内感染1例,多器官感染3例。因曲霉菌感染死亡7例,病死率为53.8%(7/13)。结论:肝移植术后曲霉菌感染死亡率高、早期诊断、及时治疗、细致护理及严格消毒隔离是降低其病死率的关键。

原位肝移植已成为治疗终末期肝病最有效的治疗手段,而直肠癌并肝内广泛转移实施肝移植的报道极少[1].我院对2例肝移植联合直肠癌根治术治疗晚期直肠癌并肝内广泛转移的患者,取得较好效果.现将术后护理体会报道如下.

回顾性分析11例肝移植术后胆漏病例的临床护理。提出肝移植术后密切观察引流液性质及量,早期发现胆漏;根据胆汁引流量、胆漏原因、全身情况等给予不同的护理是改善预后的关键。

Objective To summarize the nursing points of gastrointestinal perforation following liver transplantation in order to increase the nursing quality and patients survival rate after liver transplantation. Methods A retrospective study was era'tied out in 6 patients with gastrointestinal perforation following liv-er transplantation. Results Six cases of gastrointestinal perforation following liver transplantation was di-agnosed and treated in time after painstaking observation and nursing.Three patients among them were cured and discharged and the other three died of multiple organ failure at the 2th,9th and 33th days after perforation repair procedure due to large perforation and serious peritoneal infection and septic shock dur-ing the operation. Conclusions Incidence of gastrointestinal perforation and death rate following liver transplantation was high. We should gave early diagnosis and appropriate disposal in order to increase the therapeutic effect of gastrointestinal perforation.At the same time psychological nursing, basic nursing and diet nursing should be executed to improve the survival rate and life quality of patients.

目的 总结肾移植术后巨细胞病毒肺炎的护理.方法 回顾性分析56例肾移植术后巨细胞病毒肺炎患者的临床资料.结果 本组56例患者中治愈38例(68%),好转6例,8例因呼吸循环衰竭死亡,4例因脑水肿导致长期昏迷.结论 对肾移植术后巨细胞病毒肺炎的患者要特别注意与肺部体征不相符的呼吸道症状的观察,加强循环系统、营养、高热、血糖及心理方面的护理.