摘要
目的:对13例公民逝世后器官捐献(donation after citizen’s death,DCD)移植术后肾动脉破裂案例进行分析总结。方法:回顾性分析郑州人民医院器官移植中心617例DCD供肾移植受者,其中因感染因素导致移植肾动脉破裂13例,通过供受者多种途径查找致病微生物,确定感染来源。结果:受者移植肾动脉破裂时间为术后6~86 d,致病微生物包括曲霉菌、毛霉菌、热带念珠菌、肺炎克雷伯杆菌及粘质沙雷菌等。10例受者切除移植肾,1例通过介入治疗保留移植肾。死亡3例,死因为消化道大出血、重症肺炎、失血性休克。结论:在供肾获取前,应取供者血液、尿液及伤口分泌物等进行病原学监测,阳性者给予敏感药物抗感染治疗,效果不佳者果断弃用。同一供者的一个受者出现移植肾动脉破裂,另一受者也应高度重视,立即抗感染治疗。遵守"先保命再保肾"原则,若感染无法控制,应尽早切除移植肾。对病史长、感染因素不确定的供肾,术后常规应用广谱抗细菌药物联合抗真菌药物预防感染,并根据培养结果和药物敏感试验及时调整治疗方案。
Objective: To analyze and summarize 13 cases of arterial rupture of DCD renal transplantation. Method: A retrospective analysis was performed on 617 DCD kidney transplanted recipients from organ transplantation center of Zhengzhou People’s Hospital, including 13 cases of renal artery rupture caused by infection factors. Pathogenic microorganisms were searched through multiple ways of donor and recipient to determine the source of infection. Result: The time of artery rupture was 6-86 days after the operation. The pathogenic microorganisms causing artery rupture included aspergillus, mucor, tropical candida, klebsiella pneumoniae and serratia mucosa. Ten of the patients had their renal grafts removed, and one had the graft preserved by interventional therapy. Three cases died of massive gastrointestinal bleeding, severe pneumonia and hemorrhagic shock. Conclusion: Before organ donation, the donor’s blood, urine and wound secretions and other body fluids should be taken for etiological monitoring. Anti-infective therapy with sensitive drugs should be given to the cultured positive donors, and the ineffective ones should be discarded decisively. When one recipient of the same donor suffers from renal artery rupture, another recipient should also be highly valued and given empirical anti-infective drugs immediately. If the infection cannot be controlled, the transplanted kidney should be removed as soon as possible according to the principle of "life first and kidney second". For the donor kidney with a long history and uncertain infectious factors, broad-spectrum antibacterials combined with antifungal drugs should be used to prevent infection after operation, and the treatment plan should be adjusted in time according to the culture results and drug sensitivity test.
作者
王凯
李明
乔良伟
曲青山
苗书斋
WANG Kai;LI Ming;QIAO Liangwei;QU Qingshan;MIAO Shuzhai(Organ Transplantation Center,Zhengzhou People's Hospital,Zhengzhou,450003,China)
出处
《临床泌尿外科杂志》
2020年第7期552-556,共5页
Journal of Clinical Urology
关键词
肾移植
动脉破裂
公民逝世后器官捐献
感染
kidney transplantation
arterial rupture
donation after citizen's death
infection
