106例严重肾损伤诊疗体会

Diagnosis and treatment for 106 cases of severe renal injury

目的:探讨严重肾损伤的有效诊疗措施,以期提高抢救成功率。方法:回顾性分析2006年1月～2011年12月收治的严重肾损伤患者106例的临床资料,其中Ⅲ级33例,Ⅳ级62例,Ⅴ级11例。以48小时为时间观察点,观察患者的尿液颜色、生命体征、血红蛋白变化情况,结合彩超、CT结果,根据情况决定手术抑或保守治疗。结果:保守治疗成功41例,成功率38.7%;45例行肾切除,切除率42.5%。肾切除组收缩压、血红蛋白分别下降(46.0±13.1)mmHg和(3.9±0.7)g,而非肾切除组下降(22.0±8.3)mmHg和(2.0±0.5)g,两组比较差以有统计学意义(P<0.01)。本组患者明显血尿59例,彩超检查诊断准确率为52.8%(56例),CT准确率为97.2%(103例),两组比较差异有统计学意义(χ2=55.6,P<0.01)。结论:血尿与肾损伤严重程度不一致,血压、血红蛋白下降情况才是判断肾损伤严重程度的重要指标;CT可作为肾损伤分级及是否手术的重要依据;血压/血红蛋白进行性下降是手术探查的绝对指征。

Objective：To explore the effective diagnosis and treatment of severe renal injury and to improve the success rate of rescue of severe renal injury. Methods： The clinical data of 106 cases of severe renal injury in last 6 years were retrospectively analyzed. Each of the degree from Ⅲ to Ⅴ included 33, 62, and 11 cases respectively. Variation of hematuria,hemachrome and vital sign in all of the 106 cases was observed in 48 hours. Results：41 cases accepted conservative treatment, the success rate was 38.7%, 45 cases accepted nephrectomy, the resection rate was 42.5%. The fall of blood pressure and hemachrome in nephrectomy group was （46.0±13. 1）mmHg, （3.9±0.7）g ,but in conservative treatment was （22.0±8.3） mmHg, （2.0±0.5）g and the difference was significant（P〈0.01）. 59 cases were discovered severe hematuria. The accurate rate of diagnosis was 52.8% in Colour Ultrasound, but 97.2% in MSCT and the difference was significant（P〈0.01）. Conclusions：The severity of Hematuria is inconsistent with that of renal injury . It is important that the degree of blood pressure and hemachrome has fallen. CT is sound basis for the classification and surgical treatment of renal injury. It is absolute indication of operative surgery that blood pressure and hemachrome is going down .