急性局灶性肾梗死诊疗分析

Diagnosis and treatment of acute focal renal infarction

目的 探讨急性局灶性肾梗死的诊断和治疗方法. 方法回顾性分析3例急性局灶性肾梗死患者的资料.年龄53（45,52,63）岁.以腰腹胀痛就诊2例,以上腹痛就诊1例.疼痛时间1～4 d,平均3 d.行B超和双肾CT检查均提示局灶性肾梗死,左肾2例,右肾1例.实验室检查：白细胞（12.0～15.8）×10^9/L,中性0.78～0.86;尿蛋白0.48～0.86 g/24 h,酮体＋～＋＋;天冬氨酸转氨酶（AST）48～126 U/L,乳酸脱氢酶（LDH）320～430 U/L,谷氨酰转肽酶（GTP）73～96 U/L,血SCr 85～230μmol/L,BUN 11.5～15.5 mmol/L.应用数字减影血管造影（DSA）及溶栓抗凝治疗,并结合文献对急性肾梗死的疗效进行分析. 结果 3例治疗均获成功.2例行DSA,并予尿激酶100万U溶栓治疗,第3天再次利用原DSA管造影,见肾动脉通畅.另1例予哌替啶50 mg、黄体酮20mg止痛解痉处理,予丹参注射液静脉滴注及低分子肝素6000 U抗凝治疗,1 d后疼痛缓解.1周后复查CT示3例肾梗死灶明显消失.实验室检查结果均恢复正常.3例随访0.5～2年,平均1.5年,均痊愈. 结论 急性肾梗死的诊断主要依靠B超和CT检查,溶栓抗凝治疗效果主要取决于早期发现和及时治疗,临床医师需提高对肾梗死的认识.

Objective To review the clinical diagnosis and treatment of acute focal renal infarction. Methods Three cases of focal renal infarction were reported and the literature was reviewed.The patients aged from 45 to 63 years with mean age of 54. Two cases had low back pain, 1 case with abdominal pain. Based on clinical history, B-ultrasonography and CT scan, focal renal infarction was diagnosed in 3 patients. There were 2 cases on left kidney and 1 case right. All cases were applied digital subtraction angiography （DSA） and thrombolytic anticoagulant therapy. Results Two cases received DSA and thrombolytic therapy. The other one case received pethidine 50 mg, progesterone 20 mg treatment, the salvia infusion and low molecular heparin 6000 U anticoagulant therapy. All patients had symtoms relieved after 1 d. A week later CT scan, 3 cases of renal infarction were apparently disappeared. Serum creatinine and urea nitrogen were normal. Three patients were followed, mean follow-up time was 1. 5 （0. 5-2） years. Conclusions The diagnosis of acute focal renal infarction mainly depends on B-ultrasound and CT. Early diagnosis and treatment is important for achieving recovery of the compromised renal function. Renal infarction should be suspected in the presence of abdominal pain of sudden onset.