急性肾后性肾功能衰竭合并尿源性脓毒症的诊治体会

Diagnosis and treatment experience of postrenal acute renal failure complicated with urinary-derived sepsis

目的:探讨急性肾后性肾功能衰竭合并尿源性脓毒症的诊疗方法。方法:回顾性分析2013年2月~2016年8月我院泌尿外科收治的6例急性肾后性肾功能衰竭合并尿源性脓毒症患者的临床资料。6例患者均为结石导致急性肾后性肾功能衰竭并继发尿源性脓毒症,入院后积极建立透析通路行血液净化治疗,早期应用碳青霉烯类抗生素,并液体复苏、强心、抑酸治疗,预防多脏器功能衰竭出现。结果:6例患者体温均于24h内得到控制,生命体征稳定后4例患者行肾穿刺造瘘,2例放置双J管解除肾后性梗阻。最终1例患者肾功能停留至氮质血症期,余5例患者肾功能恢复正常后行外科手段处理结石康复出院。结论:急性肾后性肾功能衰竭合并尿源性脓毒症来势凶险,治疗措施包括紧急行血液净化稳定内环境,清除内毒素,敏感抗生素控制炎症反应,预防疾病发展至多器官功能障碍综合征(MODS)。生命体征稳定后尽早解除肾后性梗阻,并留取梗阻段以上尿液行培养指导抗菌谱。

Objective：To investigate the diagnosis and treatment of postrenal acute renal failure complicated with urinary-derived sepsis.Method：We retrospectively reviewed the clinical data from February 2013 to August 2016 in our department including 6 cases of postrenal acute renal failure complicated with urinary-derived sepsis.All cases were diagnosed as acute renal failure caused by calculus and secondary urinary-derived sepsis followed.After admission,they immediately received hemodialysis.They were administered carbapenems antibiotics early,fluid resuscitation,cardiac and acid suppressive therapy to prevent the multiple organ failure.Result：All 6 patients＇ temperatures were controlled within 24 h.After all of their vital signs became stable,4 of the 6 patients received percutaneous nephrostomy and 2 cases were placed double-J tube in order to remove postrenal obstruction.One case＇s renal function stayed in the period of azotemia in the end,and the remaining 5 patients were used surgical method to deal with stones after their renal function recovered to normal.Conclusion：Postrenal acute renal failure complicated with renal urinary-derived sepsis seems menacing.The treatment measures include emergency blood purification to stabilize the internal environment of body,eliminating the endotoxin,adopting sensitive antibiotics to take control of inflammation and preventing multiple organ dysfunction syndrome.After patients start to have stable vital signs,the renal obstruction should be removed as soon as possible,and the urine sample above line of the obstruction should be cultured in order to make the antibacterial spectrum clear.