| Since the 1st the allograft kidney transplantation of U.S.A. succeeded in 1954, kidney transplantation has become the best choice for the patients with end stage renal disease to recover healthy and vigorous life. Diuresis stage is one of the period that most patients will experience after the kidney transplantation. Therefore, the observation and maintenance of water and electrolyte balance at this stage have been the clinical focus all the time. However, there are few researches and reports of characters of urine change after kidney transplantation which is an important instructive clinical basis for fluid infusion. At present, the scheme of fluid infusion issue in diuresis stage varies in different kidney transplantation centers home and aboard and it is reported that all kinds of schemes can play a role in keeping the water and electricity balance and acid-base balance. But various schemes, to more or less degree have a great deal of inconveniences, such as different conversion, need to adjust temporary adjustment of electrolyte convert, frequent change of fluid and so on. At the same time, nurses have to invest a large amount of time and energy to cooperate with the treatment, which is unfavorable for nurses to observe the complications after transplant operation. This study attempt to optimize the present fluid infusion scheme and develop a special fluid which is used in diuresis stage after kidney transplant on the basis of finding out the characters of much urine changing, so as to help patients live though the diuresis stage safely, reduce the danger of contamination of infused fluid and work load of nurses.Part 1 Research on characters of the changes of urine composition and osmotic pressure in diuresis stage after kidney transplantation. 30 patients (the patient with diabetes mellitus was ruled out) in diuresis stage after the kidney transplant were selected. The multiple indexes, such as electrolyte and metabolite inthe urine, osmotic pressure and urine volume etc. were measured at 1h, 5h, 9h, 13h, 17h, 21h after operation. Investigate the character of urine changes in diuresis stage after the operation of kidney transplant.The results suggested: (1)Peak value of urine volume appears in 3h to 9h after the operation during the diuresis stage. Urine volume reduces to 300ml/h gradually since 15h after the operation. It indicated that it is the key period of time for fluid infusion after operation and the nurses should strengthen fluid infusion control; (2)The density of the sodium ion and chloride in the urine were similar with those in normal person's urine, while the density of the potassium ion and of calcium ion were lower than those in normal person's urine, which indicated that while making the fluid infusion scheme, the density of the calcium ion in the liquid should be increased and the content of other ion should be close to the density of there in the blood; ?The sodium ion density in the urine was at peak lh after operation, dropped gradually later(P<0.05)and became unchanged 9h; ?The discharge of potassium ion in diuresis stage was relatively invariable after the operation and there was no remarkable difference between every given time (P>0.05); ? The density of chloride and calcium ion in the urine is highest lh after operation, dropped (P<0.05) gradually and became unchanged in 13h after the operation; ?The osmotic pressure of urine has no obvious change with time after operation (P> 0.05), which indicated that the measurement of osmotic pressure is not suitable as monitoring index of renal function recovery after transplant operation; ?Value of creatinine and urea in the urine increased gradually, reached the peak value 13h after the operation (P<0.05) and remained relatively stable from then on. The urine glucose was positive on each time point in the diuresis stage. All of these indicated that they might be the important reasons for the increased volume of the urine.Part 2. The evaluation of the scheme of fluid infusion used in ChangZheng Hospital during diuresis stage after the kidney transplantion. 30 patients (the patient with diabetes mellitus was ruled out) in diuresis stage after kidney transplantation were collected as research objects. Immediately before transplant operation and the each chosen time (lh, 5h, 9h, 13h, 17h, 19h) after the kidneytransplant operation, measure indexes such as kidney's function, the blood electrolyte, blood pressure, serum glucose, urine glucose and carbon dioxide combining power etc, to determine the effect of fluid therapy. The result showed: ?The value of potassium, sodium and chlorine was within normal limits on each spot time. Serum calcium value was slightly lower than the normal range; ?The level of creatinine and urea in the serum dropped steadily after the operation and the kidney function tended to be normal; ?The level of serum glucose and urine glucose was notably higher than normal value, presenting positive correlation after the operation. And its coefficient correlation has statistic meaning (P<0.05); ?The carbon dioxide combining power was in the normal range on each given time after the operation; ?The blood pressure remained unchanged (P> 0.05 ).Part 3. Modified scheme of fluid infusion and its clinical application and appraisement. The patients with end stage kidney diseases (the patient with diabetes mellitus was ruled out) were collected as the research objects and divided into 2 groups: test group and control group at random. The traditional method of fluid therapy and the modified method of fluid therapy were adopted in 2 groups respectively after kidney transplantation. Multiple indexes, such as kidney function, blood electrolyte, serum glucose, urine glucose and carbon dioxide combining power etc. were measured before and after the operation. The effects of two fluid infusion schemes on patient's kidney function recovery, blood electrolyte, acid-base equilibrium and serum glucose were examined. And the operation time of fluid infusion spent by nurse was determined and the workloads of nurses in these 2 schemes were compared.The result suggested: ?The level of test group's serum potassium, sodium, chlorine in test group was in the normal range, while the serum calcium value in control group was slightly lower than the normal range; ?The level of creatinine and urea of both group drops steadily after operation and kidney function tended to be normal; ?The level of serum glucose and urine glucose of control group was remarkably higher than normal value notably. Although the level of serum glucose after operation in test group is higher than normal range, but the value is notably lower than that of control group (P<0.05); (4) The carbon dioxide combining power of both groups was within the normal range on each spot time; ?The blood pressure of both groups keeps steady (P> 0.05). ? Operation time of fluid therapy spent bynurses in test group is obviously less than that of control group (P<0.05). The frequencies adding medicine and changing liquid are obviously less than these of control group (P<0.05).Conclusions:1. The urine volume peak appeared 3h-9h after the kidney transplant operation. If the donated kidney is known of good quality, while the patient's urine volume continuously remains less than lOOml/h or does not reach peak value 3h-9h after operation, nurses should closely monitor the patient's vital signs, such as blood pressure and determine weather the insufficient perfusion of kidney occurs because of insufficient fluid infusion and too low blood pressure, and then report to the doctor to deal with it in time. If urine volume is continuously remains too much 15h later after the operation, the nurses should reduce the volume of liquid appropriately on the basis of maintaining a steady blood pressure to prevent the prolonged of diuresis stage caused by excessive fluid infusion.2. The patients' hydrouria after kidney transplant operation may be related to the furosemide that is used at the end of operation, as well as the osmotic diuresis caused by the glucose and urea in the urine. However the contribution of damaged function of renal tubule while the kidney is kept in oxygen deficiency and low-temperature has not been verified3. Since the patient loses a large amount of electrolyte during the diuresis stage after the kidney transplant operation, electrolytes should be supplemented in time. The sodium and chlorine ion density in the infused liquid should be close to those in the blood. The density of the calcium ion should be measured properly. The patients with chronic renal failure have hyperpotassaemia before operation to more or less degree, therefore the kalium supply should not be too much and it might be suitable that the density of kalium infused is close to the lower limit of normal range of serum kalium.4. Because of continuous fluid infusion after operation, the determine of osmotic pressure of urine or specific gravity of urine are not suitable as the index for evaluating the recovery of concentrate and dilute function of the transplanted kidney has recovered.
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