目的:探讨移植肾IgA肾病的预防及护理措施.方法:对经穿刺活检确诊的102例移植肾IgA肾病的临床表现与检查结果进行分析,制定相应的护理方案.结果:本组病人在确诊后,采用低剂量激素口服维持方案,结合低蛋白血症及其他并发症的针对性护理,术后5年累积生存率为94.7％,平均随访时间(7.6±3.7)年.接受针对性护理者在血清白蛋白(39.8±7.2 g/L和33.2±10.7 g/L,P<0.01)及收缩压(144.6±13.6 mmHg和166.5±21.8 mmHg,P<0.01)等临床指标上显著优于未接受针对性护理者.结论:移植肾IgA肾病的针对性护理,需注重血压和饮食的控制,低蛋白血症和呼吸道感染的预防,以及良好的治疗依从性.

国内缺乏肾移植术后包裹性腹膜硬化症(EPS)护理经验的报道,本文报道我中心收治的2个案例.2例患者术前腹膜透析时间分别为17年和11年,均曾发生腹膜炎,肾移植术后出现顽固性消化道症状或腹部症状,经检查诊断为EPS.在护理过程中,护士需充分了解患者术前腹透情况,识别高危因素,警惕EPS发病,术后加强腹膜透析管护理,预防EPS发生,同时密切观察病情变化,协助EPS的及时诊断,EPS治疗时则需积极控制感染,保证充分引流,给予营养支持及做好心理护理.2例患者肾功能均恢复良好,其中1例EPS得到控制,另1例因肠瘘、持续重度营养不良而放弃治疗出院.全面系统的护理服务有利于患者积极配合治疗,提高治疗效果,促进患者身心康复.

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 探讨问题解决疗法对肾脏移植手术患者焦虑(SAS)、抑郁(SDS)的影响,为临床的诊断和治疗提供科学依据.方法 选取2015年6月至2018年6月我院接受治疗的86例肾脏移植手术患者为研究对象,按照随机数表法将其分为观察组45例和对照组41例,对照组接受常规护理,观察组在对照组基础上接受问题解决疗法,1个月后,比较两组患者的SAS,SDS量表评分以及希望水平评分.结果 两组患者干预前SAS,SDS评分比较差异无统计学意义(P>0.05),干预后,观察组患者的SAS,SDS评分低于对照组(P<0.05);两组患者干预前希望水平比较差异无统计学意义(P>0.05),干预后,观察组患者希望水平评分高于对照组(P<0.05).结论 问题解决疗法对缓解肾脏移植手术患者的负性情绪具有积极作用,能够提高患者的希望水平,临床应进一步推广应用.

目的 探讨激励式护理在降低肾脏移植手术患者负面情绪,提高患者自我管理能力、生活质量和满意度的影响.方法 选取2013年7月至2017年10月在我院接受肾脏移植手术的82例患者,按照随机数表法等分为试验组和对照组.对照组采用常规肾脏移植护理方法,试验组在对照组的基础上采用激励式护理.采用自我管理能力测定量表评价两组患者的自我管理能力,两组患者分别于干预前和干预后使用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者焦虑、抑郁程度,采用生活质量综合评定问卷评价两组患者的生活质量;采用纽卡斯尔护理满意度量表统计两组患者的护理满意度.结果 试验组患者饮食、治疗、躯体活动、社会心理以及自我管理能力总分均高于对照组,差异有统计学意义(P<0.05).干预前两组患者SAS,SDS评分差异无统计学意义(P>0.05),干预后试验组患者SAS,SDS评分均明显低于对照组,差异有统计学意义(P<0.05);试验组患者躯体功能、心理健康、社会功能方面的生活质量评分均高于对照组(P<0.05),两组患者的物质生活状态评分经比较无统计学意义(P>0.05).试验组患者满意度明显高于对照组,差异有统计学意义(P<0.05).结论 激励式护理可以有效地降低患者的负面情绪,提高患者的自我管理能力、生活质量和满意度,值得临床推广.

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 compare high performance liquid chromatography (HPLC) and enzyme multiplied irmunoassay technique (EMIT) method in monitoring mycophenolic acid (MPA) in renal transplantation patients.Method Plasma samples were collected from 31 adult kidney transplant recipients at 0.5,1.5,4 and 9 h after administration of mycophenolate mofetil (MMF).All these patients were given MMF,tacrolimus and prednisolone for immunosuppression.Both EMIT and HPLC were employed to determine plasma MPA concentration.Method comparison was performed using Bland & Altman and Passing & Bablok analysis.Result HPLC method and EMIT method exhibited a liner range of 0.1-50.0 mg/L and 0.1-15.0 mg/L.All of MPA concentrations at each time point had no normal distribution.The MPA concentration determined by EMIT was higher than HPLC by 1.44 (-1.88-13.58 rg/L,P＜0.05).The EMIT assay showed a mean positive bias of 29.0％ in concentration,and 19.4％ in AUC0-12h by Bland & Altman plots.The Passing & Bablok regression analysis gave an equation of MPAEMTT =0.3926 + 1.1121 × MPAHPLC,and AUCEMIT =4.7911 + 1.0929 × AUCHPLC.Conclusion It should be considered that the putative therapeutic range for MPA with the EMIT assay is higher than the range using HPLC.

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。

本文通过探讨亲属活体儿童肾移植中供受体的围手术期护理特点，得出结论亲属活体供肾的儿童肾移植具有特殊性，应加强对供受体的术前评估及心理支持；供体术后需警惕外科并发症，并注意肾功能恢复情况。受体术后需注意维持体液平衡、协助医师评价患儿依从性及观察治疗执行情况等。术后尽早使供受体病房交流有利于双方心理恢复。长期随访要注意观察药物副作用对患儿美容、心理等的影响，并对患儿进行必要的心理辅导。

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.

Objective To investigate the pharmacokinetics of mycophenolic acid (MPA) in Chinese adult renal allograft recipients,and to generate the validated model equations for estimation of the MPA area under the plasma concentration-time curve from 0 to 12 h (AUC0-12h) with a limitedsampling strategy.Methods The pharmacokinetics in 42 Chinese renal allograft recipients treated with mycophenolate mofetil in combination with tacrolimus and corticosteroids were determined. MPA concentration was assayed by high-performance liquid chromatography (HPLC) at pre-dose (G0) and at 0.5(G0.5h),1 (C1h),1.5 (C1.5h),2 (C2h),3(C3h),4 (C4h),6 (C6h),9 (C9h) and 12 (C12h) h,respectively.The modd equations were generated by multiple stepwise regression analysis for estimation of the MPA-AUC by a limited sampling strategy.Results The prediction formulas were as follows:MPA-AUC1.5 h-4h-9 h =7.297 + 2.819C1.5 h + 3.297C4 h + 4.269C9 h ( r2 =0.878) ; and MPA-AUG0.5 h-1.5 h-4 h-9 h =2.519 + 0.549G0.5 h + 1.900 C1.5 h + 3.931 C4 h + 4.037C9 h (r2 =0.928).We plotted the average of estimated AUC and full MPA-AUC0-12 h.The Bland 8 Altman analysis indicated good agreement to within 1.96SD.Mean difference of the prediction formula using the three time points of C1.5 h-C4 h-C9 h was (11.7 ± 8.32) mg·h·L-1 and 95％ confidence interval (CI) was (9.18～14.37) mg·h·L-1,p＜0.01 ; mean difference of the prediction formula using the four time points of G0.5 h-C1.5 h C4 h-C9 h was (1.65-±7.98) mg·h·L-1,and 95％ CI (-0.84～4.13) mg·h·L-1,P＜0.01.Conclusion This limited sampling strategy provides an effective approach for estimation of full MPA AUC0-12 h in Chinese adult renal allograft recipients treated with mycophenolate mofetil in combination with tacrolimus in the stable post transplant period.

Objective:To evaluate the clinical observation and nursing of highly sensitized recipients(HSP) with kidney transplantation after desensitization therapy.Methods:The clinical and nursing data of 35 HSPs received kidney transplantation after desensitization therapy with plasmapheresis plus intravenous immunoglobulin were retrospectively analyzed.The monitoring and nursing experience were summarized.Results:No hyperacute acute occurred.There were 10 cases of acute rejection,including 6 cases of early severe acute humoral rejection,one case suffered from graft rupture and treated by surgical repair,another suffered from acute tubunar necrosis and treated by 7 weeks of hemodialysis,all grafts recovered well.Through tight surveillance and careful nursing,severe infection complications were avoided.Conclusions:The desensitization therapy before transplantation,tight surveillance and careful nursing for complications were helpful to successful kidney transplantation of HSP.The key points of nursing for these recipients are early finding signs and symptoms of rejection and prevention from infective complications.

In the present study, polysaccharides were isolated from Ganoderma lucidum and their effects on myocardial collagen cross-linking were discussed in high-fat-diet/streptozotocin diabetic rats to investigate whether collagen-linked advanced glycation end products (AGE) and antioxidant enzymes were involved in the progress. Rats were grouped into the normal control, diabetic control and polysaccharides-treated groups. Blood glucose, insulin, blood fat, antioxidant enzymes activities, myocardial collagen and AGE were measured. After polysaccharides treatment, blood glucose and fat decreased, while insulin increased. It was also found that G. lucidum polysaccharides attenuated myocardial collagen cross-linking in diabetic rats, which was related to the decreased level of AGE and augmented activities of antioxidant enzymes. The results provided a possible use of G. lucidum polysaccharides in the treatment of myocardial fibrosis of diabetes.

[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.

OBJECTIVETo understand clinicopathologic characteristics of hand-foot-and-mouth disease.METHODSThe data of two autopsy cases with brainstem encephalitis caused by enterovirus type 71 infection were analyzed.RESULTSThe age of the two patients was younger ( < or = 3 age). The clinical course was rapidly progressive, vesicular rashes were found in one case and the other case had no rashes. Both patients had clinical manifestations of central nervous system. Rapid progression to death were preceded by the development of pulmonary edema and hemorrhage. The results of the autopsy showed that the brain and brain stem were most severely involved and there were inflammation and necrosis. There were lung edema and hemorrhage. The myocardium and other organs were not infiltrated by inflammatory cells.CONCLUSIONHand-foot- and-mouth disease with enterovirus type 71 infection often affected central nervous system, rapid progression to death was preceded by the development of brain stem encephalitis and pulmonary edema.