85例重度肾损伤患者早期血管腔内介入治疗的临床分析

Clinical analysis of early endovascular interventional treatment in 85 patients with severe renal injury

目的:探讨重度肾损伤早期血管腔内介入治疗结局的影响因素。方法:回顾性分析2010年1月至2018年8月收治的85例重度肾损伤早期接受血管腔内介入治疗患者的临床资料,通过单因素和多因素logistic回归分析年龄、性别、致伤因素、损伤部位、美国创伤外科协会(American Association ofTraumaticSurger y,A A ST)分级、有无多发伤以及合并何种类型多发伤等指标对重度肾损伤患者早期血管腔内介入治疗失败(需要外科手术或再次介入治疗)和患者死亡的影响。结果:本组85例重度肾损伤患者中,IV级肾损伤57例(67.1%)、V级肾损伤28例(32.9%)。本组早期血管腔内介入治疗成功率为85.9%(73/85),其中IV级肾损伤介入治疗成功率显著高于V级[96.5%(55/57)v s6 4. 3%(1 8/2 8),χ~2=1 6. 0 6 2, P <0. 0 0 1],多因素分析发现A A STV级是导致重度肾损伤早期介入治疗失败的独立危险因素(OR=2.37,95%CI:1.15～3.28,P=0.016)。本组住院期间病死率为1 7. 6%(1 5/8 5),老年(≥6 5岁)、 A A STV级、多发伤、合并骨盆骨折、合并其他内脏损伤患者病死率显著升高(均P<0.05)。多因素分析发现只有AASTV级(OR=1.16,95%CI:1.07～2.55,P=0.023)、合并骨盆骨折(OR=1.49,95%CI:1.27～4.10,P=0.011)、合并其他内脏损伤(OR=1.25,95%CI:1.11～2.93,P=0.020)是重度肾损伤患者死亡的独立危险因素。结论:在血流动力学稳定的前提下,早期血管腔内介入治疗对于重度肾损伤尤其是AAST IV级肾损伤具有较高的安全性和有效性,但AAST V级、合并骨盆骨折和其他内脏损伤可能在一定程度上影响技术成功率和预后。

Objective: To investigate the factors influencing the outcome of early endovascular interventional treatment for severe renal trauma. Methods: The clinical data of 85 patients with severe renal trauma who underwent endovascular interventional therapy from January 2010 to August 2008 were retrospectively analyzed. Univariateand multivariate logistic regression was used to analyze the clinical variables, including age, gender, injury factors,site of injury, American Association of Traumatic Surgery (AAST) classification, multiple injuries, and types ofmultiple injuries, associated with failure (requiring surgery or re-intervention) of early endovascular interventiontreatment, and investigating the factors that led to death in patients with severe renal trauma. Results: Among85 patients with severe renal trauma, 57 (67.1%) were grade IV and 28 (32.9%) were grade V. The success rateof early endovascular interventional therapy was 85.9% (73/85). The success rate of grade IV renal injury wassignificantly higher than that of grade V [96.5% (55/57) vs 64.3% (18/28), χ2 =16.062, P<0.001]. Multivariateanalysis showed that AAST grade V was an independent risk factors of failure of early interventional therapyfor traumatic severe renal trauma (OR =2.37, 95%CI 1.15–3.28, P=0.016). The mortality rate was 17.6%(15/85) during hospitalization. The mortality of elderly (aged 65 years old or above), AAST grade V, multipleinjuries, concomitant pelvic fractures and concomitant other visceral injuries were significantly higher (P<0.05).Multivariate analysis showed that only AAST grade V (OR =1.16, 95% CI 1.07–2.55, P=0.023), concomitantpelvic fractures (OR =1.49, 95% CI 1.27–4.10, P=0.0111), and concomitant other visceral injuries (OR =1.25,95% CI 1.11–2.93, P=0.020) were independent risk factors for death in patients with severe renal trauma.Conclusion: On the premise of hemodynamic stabilization, early endovascular interventional therapy is safe andeffective for severe renal trauma, especially AAST grade IV renal injury, but AAST grade V, concomitant pelvicfractures and other visceral injuries may affect the technical success rate and prognosis to some extent.