AKI肾穿刺活检术后肾周血肿与术前透析干预相关性研究

Clinical study of correlation between perirenal hematoma after renal biopsy in patients with AKI and preoperative dialysis intervention

目的探讨急性肾损伤(acute kidney injury,AKI)肾穿刺活检术后肾周血肿与术前透析干预相关性。方法回顾性分析行肾穿刺活检术AKI患者180例的临床资料,根据术前有无接受透析干预和术后有无出现肾周血肿分组,比较不同组基线临床特征资料和术后出血指标,采用Logistic回归法分析肾穿刺活检术后肾周血肿的危险因素。结果①透析组AKI 2~3期比例、肌酐及尿素氮水平均显著高于未透析组(P<0.05);透析组血红蛋白水平显著低于未透析组(P<0.05);②入选患者术后24 h肾脏超声证实出现肾周血肿108例,占比为60.0%,其中透析组46例,未透析组62例;透析组和未透析组术后肾周血肿发生率比较差异无统计学意义(P>0.05);透析组术后血红蛋白水平显著低于未透析组(P<0.05);③肾周血肿组和非肾周血肿组基线临床特征资料比较差异无统计学意义(P>0.05);④Pearson法评估结果显示,肾穿刺活检术后肾周血肿发生与术前血液透析治疗无相关性(r=0.34,P=0.26);多因素分析结果显示,肾穿刺活检术术后肾周血肿直径≥5 cm风险与术前血液透析治疗亦无相关性(r=0.27,P=0.35)。结论肾穿刺术前透析干预难以有效降低或避免肾穿刺活检术后出血风险。

Objective To investigate the correlation between perirenal hematoma after renal biopsy in patients with AKI and preoperative dialysis intervention.Methods Clinical data of 180 AKI patients with renal biopsy were retrospectively chosen.All patients were divided different groups according to whether or not dialysis intervention before operation and perirenal hematoma after operation.The baseline clinical characteristics and the indexes of postoperative hemorrhage of different groups were compared,and the correlation between the perirenal hematoma and the preoperative dialysis intervention by logistic regression method were analyzed.Results①The proportion of AKI 2-3 stage,Cr and BUN levels in dialysis group were significantly higher than non-dialysis group(P<0.05).The Hb level of dialysis group was significantly lower than non-dialysis group(P<0.05).②108 cases(60.0%)were confirmed to have perirenal hematoma by renal ultrasound 24 hours after operation.Among them,there were 46 cases in dialysis group and 62 cases in non dialysis group.There was no significant difference in the incidence of postoperative perirenal hematoma between dialysis group and non-dialysis group(P>0.05).The level of Hb of dialysis group was significantly lower than non-dialysis group(P<0.05).③There was no significant difference in baseline clinical characteristics between 2 groups(P<0.05).④Pearson method evaluation results showed that there was no correlation between the occurrence of perrenal hematoma after renal biopsy and preoperative hemodialysis(r=0.34,P=0.26);the results of multivariate analysis showed that the diameter of perinephric hematoma after renal biopsy There is no correlation between the risk of≥5 cm and preoperative hemodialysis treatment(r=0.27,P=0.35).Conclusion Dialysis intervention before renal puncture is difficult to effectively reduce or avoid the risk of bleeding after renal biopsy.