肾移植术后移植物功能延迟恢复诊疗技术规范(2019版)

中华医学会器官移植学分会

doi:10.3969/j.issn.1674-7445.2019.05.010

肾移植术后移植物功能延迟恢复诊疗技术规范(2019版)

doi: 10.3969/j.issn.1674-7445.2019.05.010

中华医学会器官移植学分会^,

100091 北京，中国人民解放军总医院第八医学中心(石炳毅、陈莉萍)；山西省第二人民医院(李宁)

基金项目:

国家自然科学基金 81570680

国家自然科学基金 81571555

详细信息

通讯作者:
石炳毅，Email：shibingyi666@126.com；李宁，Email：sxtylining666@126.com

中图分类号: R617
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- 被引次数: 0
出版历程
- 收稿日期: 2019-06-28
- 网络出版日期: 2021-01-19
- 刊出日期: 2019-09-15

Technical specification for the diagnosis and treatment on delayed graft function after renal transplantation (2019 edition)

Branch of Organ Transplantation of Chinese Medical Association^,

摘要

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。
- 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

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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

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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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