不同血液净化方式与移植肾功能的延迟恢复

摘要

背景:肾功能延迟恢复是肾移植后急性肾功能衰竭的一种形式,大多由缺血再灌注损伤和排斥反应等原因所致,血液净化作为治疗肾功能延迟恢复的基本手段已得到广泛应用.目的:比较不同透析方法对肾移植后肾功能延迟恢复的影响,以期选择合适的透析方法,提高移植效果.方法:56例移植肾功能延迟恢复患者分别应用血液透析(n=25),血液透析滤过(n=21)和腹膜透析(n=10)治疗,观察应用不同透析方法治疗前后血压、细胞因子水平和疗效.结果与结论:56例肾功能延迟恢复患者均带肾存活.血液透析滤过组和腹膜透析组低血压发生率低于血液透析组 (P < 0.01),血液透析滤过组肾功能恢复时间短于血液透析组和腹膜透析组(P < 0.01);术后感染发生率:血液透析滤过组<血液透析组<腹膜透析组(P均<0.01).血液透析滤过组透析后4 h的肿瘤坏死因子α、白细胞介素1β、白细胞介素6水平较透析前下降,差异有显著性意义(P < 0.01),而血液透析组透析前后差异无显著性意义(P > 0.05).结果可见移植肾功能延迟恢复患者经血液透析滤过后血液动力学稳定,能有效减轻炎症反应,缩短移植肾功能恢复的时间.%BACKGROUND: The delayed recovery of renal function after renal transplantation is one form of acute renal failure, mostly resulting from ischemia-reperfusion injury and rejection, blood purification has been widely utilized as a basic treatment approach of delayed recovery of renal graft function.rnOBJECTIVE: To compare the efficacy of different dialysis methods on delayed recovery of renal function, to select the appropriate dialysis methods and to improve transplantation efficacy.rnMETHODS: A total of 56 patients with delayed recovery of renal graft function after transplantation were respectively treated with hemodialysis (n=25), hemodialysis and filtration (n=21) and peritoneal dialysis (n=10), to observe blood pressure, cytokines levels and efficacy before and after different dialysis treatments.rnRESULTS AND CONCLUSION: Totally 56 patients with delayed graft function survived with renal graft. Compared with hemodialysis and peritoneal dialysis groups, the incidences of hypotension and postoperative infection were lower in hemodialysis and filtration group (P < 0.01), and the recovery time of renal function was shorter (P < 0.01). There was no significant difference in the incidences of hypotension and the recovery time of renal function between hemodialysis group and peritoneal dialysis group. The incidence of postoperative infection in the peritoneal dialysis group was higher than that in hemodialysis group (P< 0.01). Levels of tumor necrosis factor a, interleukin-1 p and interleukin-6 after hemodialysis and filtration was significantly decreased compared with pre-dialysis levels (P < 0.01), while no significant difference was found before and after the hemodialysis alone (P > 0.05). The present study shows that, hemodialysis and filtration can stabilize the hemodynamics, effectively reduce inflammation, and shorten time for renal function recovery in patients with delayed graft function after transplantation.