Technical specification for the diagnosis and treatment on delayed graft function after renal transplantation (2019 edition)
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摘要: 为了进一步规范肾移植术后移植物功能延迟恢复(DGF)的诊断与治疗,中华医学会器官移植学分会组织器官移植学专家从DGF的发病机制、危险因素、诊断、预防、治疗、预后等方面,制订本规范。
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关键词:
- 器官移植 /
- 肾移植 /
- 移植物功能延迟恢复(DGF) /
- 急性肾损伤(AKI) /
- 缺血-再灌注损伤(IRI) /
- 血清肌酐(Scr) /
- 急性肾小管坏死(ATN)
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表 1 DGF发生的危险因素
Table 1. Risk factor for the occurrence of DGF
分类 危险因素 供者因素 高龄
高血压或糖尿病
终末Scr上升
死因为缺氧或脑血管病
DCD
体质量指数高受者因素 男性
糖尿病病史
透析病程长
体质量指数高
虚弱
群体反应性抗体高
多次移植
术前输血其他 冷缺血时间延长
热缺血时间延长
人类白细胞抗原错配数高表 2 DGF的病因
Table 2. The cause of DGF
分类 病因 肾前性因素 血容量不足
心输出量减少
外周血管扩张
肾血管严重收缩肾实质或肾
血管因素急性肾小管坏死
急性加速性或急性排斥反应
血管性微血管病
移植肾原发性肾小球疾病复发
间质性肾炎
肾动脉或静脉血栓形成
肾动脉狭窄肾后性因素 输尿管受压(受血肿或引流管压迫)
输尿管梗阻(血块堵塞、输尿管扭曲、输尿管膀胱吻合口狭窄)
神经性膀胱表 3 美国器官获取组织制定的器官维护目标
Table 3. The target of organ maintenance set by Organ Procurement Organization in America
指标 维护目标 平均动脉压 60~110 mmHg 中心静脉压 6~11 cmH2O 射血分数 ≥50% 血管升压类药物 低剂量,≤1种[多巴胺≤10mg/(kg·min),肾上腺素≤1 mg/(kg·min),去甲肾上腺素≤0.2 mg/(kg·min)] 动脉血气分析 pH值7.3~7.5 氧合指数 ≥300 mmHg(吸入氧浓度100%,呼气末正压5 cmH2O条件下测定) 血钠 ≤155 mmol/L 血糖 ≤10 mmol/L 尿量 过去4 h内,≥0.5 mL/(kg·h) 1 cmH2O=0.098 kPa -
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