急性肾梗死的诊疗分析

Diagnosis and treatment of acute renal infarction

目的探讨急性肾梗死的诊断和治疗方法。方法回顾性分析4例急性肾梗死患者的诊治情况。其中男3例，女1例，年龄42—63岁，均以腰腹部疼痛就诊，多伴恶心呕吐，疼痛时间1～2d。其中2例有风湿性心脏病史，1例有心房纤颤病史，1例既往体健。行彩超和CT检查均提示局灶性肾梗死。实验室检查：血白细胞9．0—14．5×10^9／L；中性粒细胞0．77—0．89；尿蛋白＋-＋＋＋，尿红细胞--＋＋；血乳酸脱氢酶330～540U／L。应用数字减影血管造影（DSA）及溶栓治疗。结果4例治疗均获成功。4例均行DSA，并予尿激酶溶栓治疗，2d后以原DSA管造影，见患侧肾动脉及分支通畅。1周后复查CT提示4例肾梗死灶基本消失，梗死区血运接近正常。结论急性肾梗死临床上易误诊和漏诊，诊断主要依靠彩超和增强CT，及时行DSA和溶栓治疗可提高治疗效率。

Objective To discuss the diagnosis and treatment method for acute renal infarction. Methods The diagnosis and treatment on 4 cases of acute renal infarction were retrospectively analyzed. There were 3 males and 1 female, aged 42-63 years. The symptoms were back and upper abdominal pain, with nausea and vomiting and the time of aching was 1-2 d. 2 cases had rheumatic heart disease. 1 case had arterial fibrillation history. 1 case was healthy formerly. The Doppler ultrasound and CT scan showed focal renal infarction. The lab assay results： blood WBC 9.0-14.5 × 10^9/L, NEUT 0.77-0.89, urine albumin ＋ - ＋＋＋, urine RBC - - ＋＋＋, serum LDH 330-540 U/L. All cases were applied with digital subtraction angiography （DSA） and thrombolytic anticoagulant therapy. Results The therapy for 4 cases were successful. 4 cases received DSA and thrombolytic therapy. The embolisms were cleared. CT scan showed that the renal infarction of 4 cases were disappeared after 1 week, and the blood perfusion of the infarction lesion was satisfactory. Conclusion Misdiagnosis and missed diagnosis of acute renal infarction are popular in clinic. The diagnosis of the disease mainly depends on Doppler ultrasound and CT. Receiving early DSA and thrombolytic therapy is efficient for acute renal infarction.