肾综合征出血热并自发性肾破裂11例临床回顾性分析

Spontaneous renal rupture in hemorrhagic fever with renal syndrome: Clinical analysis of 11 cases

目的:分析肾综合征出血热(HFRS)患者自发性肾破裂的临床特点,探讨降低其发生率的预防策略及其有效治疗措施.方法:对我院感染科2006～2008年间收治的11例HFRS并自发性肾破裂病例进行回顾性分析.结果:11例HFRS自发性肾破裂患者有明显诱因10例,多发生在少尿期,单纯左肾破裂2例,右肾破裂8例,双肾破裂1例,血小板<80×109/L者7例,内科保守治疗治愈9例,死亡2例,其中血透后死亡1例,患者家属放弃治疗后死亡1例.结论:HFRS自发性肾破裂多发生在少尿期,患者血小板计数较低,在床上翻动过多、腹内压增大,如咳嗽、解大小便为发生肾破裂的主要诱发因素.因此,HFRS少尿期患者应予严密监护,避免上述危险因素;对血小板极低者可用无肝素化透析;对大多数患者内科保守治疗仍为首选且有效的治疗措施.

AIM： To analyze the clinical features and effective treatments of spontaneous renal rupture in hemorrhagic fever with renal syndrome （HFRS） so as to lower its incidence rate. METHODS： The clinical data of 11 cases of spontaneous renal rupture in HFRS were collected and analyzed retrospectively. RESULTS： Ten of the 11 eases （2 left renal rupture; 8 right renal rupture and I both left and right renal rupture ） were found to have definite predisposing causes and most of them occurred in oliguria stage. Blood plate count （BPC） in 7 cases was below 80 × 10^9/L. With conservative treatment, 9 patients were cured. Death occurred in 2 cases, one after haemodialysis and the other due to discontinued treatment under the request from the patient＇s family. CONCLUSION： Spontaneous renal rupture occurs mostly in oliguria stage and BPC is low. HFRS patients during oliguria stage should be given intensive care and special efforts should be made to avoid risk factors such as moving the patients in the beds and increased intra-abdominal pressure due to cough or bowel movement. Non-heparinized dialysis can be used for patients with very low BPC. Conservative treatment is still an effective management for most HFRS patients.