穿刺点局部压迫时间对超声引导下经皮肾穿刺活检术后出血的影响

The effect of local compression time at the puncture site on bleeding after ultrasound-guided percutaneous renal biopsy

目的探讨延长压迫止血时间在降低超声引导下经皮肾穿刺活检术后出血相关并发症中的价值。方法回顾性分析就诊于广州市第一人民医院405例行超声引导下经皮肾穿刺活检术患者的临床资料。按肾穿刺活检术后是否立刻压迫止血及压迫时间分3组,未压迫止血为A组,压迫止血2 min为B组,压迫止血5 min为C组。记录患者性别、年龄、术前血压、凝血四项、血红蛋白、血小板等指标。记录穿刺次数,术后即刻肾周血肿及肾穿刺点出血情况。术后24 h复查肾周血肿情况及肉眼血尿情况。结果与A组、B组相比,C组术后出血相关并发症发生率更低,A组术后24 h肾周血肿发生率为62.09%,B组为62.50%,C组为44.09%,差异有统计学意义(P=0.003);A组术后24 h肉眼血尿发生率为8.79%,B组为7.29%,C组为1.57%,差异有统计学意义(P=0.030)。A组术后即刻肾周血肿发生率为52.20%,B组为53.12%,C组为38.58%,差异有统计学意义(P=0.033)。结论超声引导下经皮肾穿刺活检术后立即行压迫止血5 min,可有效减少术后肾周血肿和肉眼血尿,减轻术后疼痛,缩短卧床时间,提高手术安全性。

Objective To Explore the value of prolonging compression hemostasis time in reducing bleeding related complications after ultrasound guided percutaneous renal biopsy.Methods A retrospective analysis was conducted on the clinical data of 405 patients who underwent ultrasound guided percutaneous renal biopsy at the Guangzhou First People′s Hospital.Three groups were divided based on whether to immediately compress and stop bleeding after renal biopsy and the compression time.The group A was treated with no compression and stop bleeding,the group B was treated with compression and stop bleeding for 2 minutes,and the group C was treated with compression and stop bleeding for 5 minutes.The patient′s gender,age,preoperative blood pressure,coagulation,hemoglobin,platelets,and other indicators were recorded.The number of punctures and the immediate postoperative perirenal hematoma and bleeding at the puncture site were recorded.The perirenal hematoma and gross hematuria were re-examined 24 hours after surgery.Results Compared with the group A and the group B,the incidence of postoperative bleeding related complications in the group C was lower.The incidence of perirenal hematoma 24 hours after surgery in the group A was 62.09%,the group B was 62.50%,and the group C was 44.09%,with a statistically significant difference(P=0.003);The incidence of gross hematuria 24 hours after surgery in the group A was 8.79%,the group B was 7.29%,and the group C was 1.57%,with a statistically significant difference(P=0.030).The incidence of immediate postoperative perirenal hematoma in the group A was 52.20%,53.12%in the group B,and 38.58%in the group C,with a statistically significant difference(P=0.033).Conclusions Immediate compression hemostasis for 5 minutes after ultrasound guided percutaneous renal biopsy can effectively reduce postoperative perirenal hematoma and gross hematuria,alleviate postoperative pain,shorten bed rest time,and improve surgical safety.