不同透析方法对移植肾功能延迟恢复的影响

目的　比较不同透析方法对肾移植后肾功延迟恢复(DGF)的影响,以期选择合适的透析方法,提高移植效果。方法　观察应用不同透析方法治疗 DGF 患者时血压、细胞因子的变化和疗效。结果　采用高容量血液滤过(HVHF)治疗过程中低血压发生率 4.85%,肾功能恢复时间(9.1±4.3)d,术后感染发生率 9.52%,均较血液透析(HD)组低低血压发生率 7.8%,肾功能恢复时间(21.4±7.6)d,术后感染发生率 20%];腹膜透析组低血压发生率6.25%,肾功能恢复时间(15. 5±6. 7) d,术后感染发生率 37. 5%,后两项指标高于 HVHF 组; HVHF 组治疗后,TNF- α、IL- 1β和 IL- 6的水平较治疗前明显下降,而HD组治疗前后无明显差异。结论　高容量血液滤过是一种较好的治疗DGF的方法。

Clinical study of blood purification in the treatment of delayed graft function after renal transplantation

Objective To compare the effects of the different blood purification methods on the treatment of delayed graft function (DGF) after renal transplantation. Methods During the period from January 1998 to June 2003, a total of 54 patients received different methods of blood purification for DGF management. High volume hemofiltration (HVHF) was applied to 21 cases in HVHF group, hemodialysis (HD) to 25 cases in HD group, and peritoneal dialysis (PD) to 8 cases in PD group; and the effects of those methods were compared. Results Altogether, 103 times of HVHF, 118 times of HD and 112 times of PD were performed. The incidence of hypotension in the HVHF group (4.85%) and the PD group (6.25%) was lower than that in the HD group(17.8%) (P< 0.01). Systolic blood pressure (SBP) of the cases in HVHF and PD groups showed slighter changes than that of the cases in HD group (SBP≥20mmHg: 20.39%, 19.64% vs. 27.12%; SBP≥40mmHg: 16.5%,18.75% vs. 22.03%; SBP≥60mmHg: 0%,1.79% vs. 14.41%) (P<0.01). The graft function recovery period of HVHF group was shorter than that of the HD and PD groups (9.1±4.3d vs. 21.4±7.6d,15.5±6.7d) (P<0.01). The incidence of postoperative infection in the HVHF group (9.52%) was lower than that in the HD group(20%) and PD group (37.5% )(P<0.01). After HVHF, the level of TNF-α, IL-1β and IL-6 was decreased remarkably than before. Conclusion Compared with HD and PD, HVHF is a better choice for the treatment of DGF.