Abstract:

Objective The aim of this study is to analyze and summarize the markers，characteristics and causes of common critical values in renal transplant recipients during the perioperative period. Methods The data of gender，age，primary disease，transplantation time，critical values，complications and corresponding treatments as well as blood concentrations of immunosuppressive agents after transplantation were collected and analyzed in 283 cases of renal transplant recipients who presented with critical values between January 2018 and November 2020. Results The most common preoperative critical value of renal transplant recipients was highserum creatinine（62.7%，69/110），followed by electrolyte and acid-base disorders（27.3%，30/110）. And the most common postoperative critical value of renal transplant recipients was electrolyte and acid-base disorders（39.9%，69/173），followed by microbial isolation or culture positivity（22.0%，38/173）and abnormal bloodroutine test（15.0%，26/173）. The preoperative and postoperative mean age of patients presented with critical values were（39.3 ±12.5）years old and（45.4 ±11.6）years old（P ＜ 0.001），

respectively. And the ratio of male to female were statistically significant（78.2% vs 21.8% preoperatively and 62.4% vs 37.6% postoperatively，P ＜ 0.05）. Conclusion Renal transplant recipients are in the end stage of renal disease before transplantation，and critical values mostly occur in patients with irregular or inadequate dialysis，as well as in those with irregular follow-up. Therefore，attention should be paid to education and follow-up for the patients waiting for transplantation，to ensure regular dialysis and visits. The early emergence of critical values in renal transplant recipients is mainly dueto the changes of internal environment，electrolyte imbalance caused by polyuria or diuresis，delayed graft function，acute rejection and drug interaction. Therefore，it is necessary to strengthen monitoring and timely adjustment for postoperative patients. 

Key words:

Renal transplant, Critical values, Perioperative period

摘要：

目的 分析并总结肾移植受者围术期常见危急值的项目、特点及其原因。方法 收集 2018 年1 月至 2020 年 11 月出现危急值的 283 例次围术期肾移植受者的性别、年龄、原发病、移植时间、危急值项目、并发症和相应处理，以及移植术后免疫抑制剂血药浓度等资料并进行分析。结果 肾移植受者术前最常见的危急值是血清肌酐水平过高，占 62.7%（69/110），其次是电解质和酸碱紊乱，占 27.3%（30/110）；肾移植受者术后以电解质和酸碱紊乱最为常见，占 39.9%（69/173），其次为微生物分离与培养阳性和血常规异常，分别占 22.0%（38/173）和 15.0%（26/173）。术前和术后出现危急值的平均年龄为（39.3±12.5）岁 和（45.4±11.6）岁（P ＜ 0.001），且男女比例存在明显差异（分别为术前 78.2% 比 21.8% 和术后 62.4% 比37.6%，P ＜ 0.05）。结论 肾移植受者术前处于肾病终末期，危急值多发生于透析不规律或不充分者，以 及未规律复诊的患者，因此，对于等待移植的患者应重视宣教和随访，确保规律透析和定期复查。肾移植受者术后早期出现危急值多因机体内环境改变、多尿或利尿导致电解质紊乱、移植肾功能延迟恢复、急性排斥反应以及药物的相互作用所致。因此，对于术后患者管理要加强监测、及时调整。 

关键词:

肾移植 ；危急值 ；围术期 ,