不同病因对急性肾后性肾功能不全患者预后的影响

Influence of Different Causes on Prognosis of Patients with Postrenal Acute Renalfailure

目的:探讨不同病因对急性肾后性肾功能不全患者预后的影响。方法回顾性分析66例急性肾后性肾功能不全患者的临床资料。男51例,女15例,年龄17~80岁,平均52.7岁。SCr 331.9~1378.5umol/L,平均(645.5±248.7) umol/L;BUN11.6~44.1 mmol/L,平均(21.6±7.1)mmol/L。42例急诊行输尿管支架置入术,其中3例一侧置管失败改行肾造瘘术,合并肾结石待肾功能恢复后行二期PCNL 6例,ESWL 6例。膀胱造瘘术6例。输尿管皮肤造瘘术6例(单侧4例,双侧2例)。膀胱切开取石术1例。3例行尿道扩张后留置尿管。8例留置尿管待肾功能改善后行TURP术。根据不同病因分为肿瘤组与非肿瘤组,比较两组治疗效果。结果两组术前BUN及SCr比较无显著性差异(P>0.05)。术后肿瘤组BUN及SCr明显高于非肿瘤组(P<0.05),肿瘤组术后3d日均尿量明显低于非肿瘤组(P<0.05)。结论尽早明确梗阻原因及部位,及时解除尿路梗阻是治疗急性肾后性肾功能不全的关键,恶性肿瘤是影响急性肾后性肾功能不全患者术后肾功能恢复预后的重要因素。

Objective To explore the influence of dif erent causes on prognosis of patients with postrenal acute renalfailure.Methods 66 cases of PARF were retrospectively analyzed from 2009 to 2014.There were 51 males and 15 females,mean age 52 years.The serum contents of BUN and Cr were(21.6±7.1)mmol/L and(645.5±248.7)umol/L,respectively.42 cases performed emergency treatment of retrograde placement of double-J ureteral stent,of which 6 cases performed percutaneous nephrostomy.6 cases performed cystostomy and 6 cases performed cutaneous ureterostomy.1 case performed cystolithotomy cystolithectomy.8 cases performed trans-urethral resection of prostate(TURP)when the renal function had resumed after indwel ing catheter.Al patients were divided into two groups depending on the etiology,the treatment ef ect were compared between the two groups.Results There were no dif erences in the serum contents of BUN and Cr between two groups pre-operation(>0.05),but statistical y significant dif erences occur ed in postoperation(<0.05).Meanwhile,Urine volume in non-neoplastic group was significant more than neoplastic group at the early stage after operation(<0.05).Conclusion It is important to define obstruction reason and part and remove the obstruction early for resume the renal function.Malignancy is the risk factor of resume the renal function after operation in patients with postrenal acute renalfailure.