妊娠合并肾结石肾积水急诊治疗体会

目的探讨妊娠合并肾结石、肾绞痛或肾积水外科急诊干预治疗的方式和预后情况。方法回顾性分析本院2018年8月至2021年12月收治住院的140例妊娠合并肾结石、肾绞痛或肾积水患者临床资料。收集统计患者年龄,胎次,入院体温,妊娠时间,疼痛量表,肾结石大小,肾积水程度,既往结石积水手术史及治疗史,补钙服药史,术前血常规,C反应蛋白(CRP),降钙素原(PCT),尿常规白细胞,尿常规红细胞,外科干预方式、时间等临床资料。对比分析临床干预前后患者疼痛量表变化,以及体温、血细胞及生化指标的变化。结果140例患者中93例患者进行了外科治疗,其中91例在局部麻醉下植入输尿管支架,2例进行了肾造瘘治疗,外科干预组所有患者病情缓解;47例选择保守治疗中,9例保守无效,6例选择患侧经膀胱输尿管支架植入术后缓解,3例患者保守治疗中出现感染性休克,后续转妇产科急诊手术引产并输尿管支架植入术后缓解。保守组、输尿管支架置入组、肾造瘘组入院患者疼痛评分、入院CRP、PCT、血红细胞、血白细胞差异具有统计学意义(P<0.05)。经治疗后,三组CRP、入院的天数差异有统计学意义(P<0.05)。结论根据患者疼痛程度、CRP、PCT变化来决定及时有效的输尿管支架置入或肾造瘘是妊娠期合并肾积水肾绞痛急诊处置的关键。

Objective To investigate the mode and prognosis of emergency surgical intervention for pregnant patients with nephrolithiasis,renal colic or hydronephrosis.Methods A total of 140 pregnant patients with nephrolithiasis,renal colic,or hydronephrosis who were admitted to our hospital from August 2018 to December 2021 were reviewed.Patient's age,parity,admission temperature,pregnancy time,pain scale,renal stone size,degree of hydronephrosis,history of previous surgery and treatment for hydronephrosis,medical history of calcium supplementation,preoperative blood routine,C-reactive protein(CRP),procalcitonin(PCT),urine routine white blood cells,urine routine microscopic examination red blood cells,surgical intervention mode,time and other clinical data were collected.Patients'pain scale changes,temperature,blood cells and biochemical parameters before and after clinical intervention were comparatively analyzed.Results Surgical treatment was performed in 93 of 140 patients,91 of whom had ureteral stents implanted under local anesthesia and two had nephrostomies,and all patients in the surgical intervention group had remission of their disease.Nine of 47 cases chose conservative treatment without effect,six cases chose to be relieved after trans vesical ureteral stent implantation on the affected side,and three patients had septic shock during conservative treatment,which was relieved after emergency surgical induction in the Department of Obstetrics and Gynecology and subsequent ureteral stent implantation.There were significant differences in pain scores,admission CRP,PCT,urine routine white blood cells and urine routine microscopic examination red blood cells between patients admitted to our hospital in the conservative group,ureteral stent placement group,and nephrostomy group(P<0.05).After the treatment,the differences in CRP and days of admission among the three groups were statistically significant(P<0.05).Conclusion The decision on timely and effective ureteral stent placement and nephrostomy based on the patient's pain level,CRP,PCT changes is key to the emergency management of hydronephrotic colic in pregnancy.