尿毒症透析患者双肾摘除术后致顽固性低血压一例报告

A Report on Refractory Hypotension in Dinephrectomized Patient with Hemodialysis

目的探讨血液透析病人双肾摘除后出现顽固性低血压的治疗。方法患者男性,54岁,因结肠癌术后化疗致慢性肾功能不全,行规律性血液透析治疗4年,血压正常。18个月前B超检查发现双侧肾脏肿瘤并相继于同年6月、10月行双肾摘除术。术中摘除肿瘤病理诊断:透明细胞癌。右肾摘除后患者血压无明显特殊变化,但在左肾摘除后患者出现血压下降。透析前血压维持在90/60mmHg左右,血液透析中血压进一步下降,最低可达60/20mmHg。并出现乏力、视物模糊、直立性低血压、晕厥等症状。因血压过低而致动、静脉内瘘闭塞。结果为能保证充分透析及保持干体重,透析治疗中采用各种方法及给予中药、米多君等维持血压。目前仍间断嚼服红参等中药,血压维持在80～90/30～50mmHg之间,维持规律性透析。结论双肾摘除是治疗透析患者伴有难治性高血压的方法之一,但双肾切除后最大的弊端是难于控制的低血压。本例患者虽然并发了肾癌,但手术中如能采用部份肾切除还是可以避免顽固性低血压的发生。

Objective To investigate the treatment on refractory hypotension in dinephrectomized patient with hemodialysis. Methods A 54-year-old male patient had regular hemodialysis for chemical therapy induced chronic renal failure after the surgery treatment of colon cancer. He was diagnosed double nephrose cancer by B-mode ultrasonic examination before 18 months and underwent dinephrectomy respectively in June and October that year. The pathological report showed clear cell carcinoma. The patient＇s blood pressure was normal after right lateral nephrectomy, but it decreased to 90/60 mmHg after left lateral nephrectomy. The blood pressure became much lower about 60/ 20 mmHg in hemodialysis. He had debility, sight illegibility, orthostatic hypotension and syncope. Hypotension also caused A-V internal fistula obturation. Results To make sure we can complete hemodialysis and maintain dry weight, we used various methods including Chinese herbal medicine and midodrine to increase blood pressure. The patient takes Hongshen to keep the blood pressure 80 - 90/30 - 50 mmHg. He can maintain regular hemodialysis now. Conclusion Dinephrectomy is a way to treat the patient with uncontrolled hypertension, but it also can cause severe hypotension. It is possible to avoid hypotension by keeping a part of the kidney in the operation.