钝性肾损伤肾切除因素分析

Analysis of factors leading to nephrectomization in blunt renal injury

目的 探讨钝性肾损伤时影响肾切除的高危因素 ,以提高肾挽救率。 方法 回顾性分析我院自 1992年 1月至 2 0 0 2年 7月收治的 2 2 6例严重钝性肾损伤患者的临床资料。 结果 2 2 6例钝性肾损伤患者 ,保守治疗 15 3例 ,手术治疗 73例。其中肾切除术 2 7例 ,术前平均输血6 33ml,平均损伤严重度评分 (ISS) 39.6分 ,入院时平均收缩压 (SBP) 85 .4mmHg (1mmHg =0 .133kPa) ;肾部分切除术 12例 ,术前平均输血 4 87ml,平均ISS 2 7.8分 ,入院时平均SBP99 .7mmHg ;肾修补术 34例 ,术前平均输血 2 6 2ml,平均ISS 2 3.6分 ,入院时平均SBP 112 .3mmHg。 结论 钝性肾损伤的严重程度与血尿的发生不相一致 ,切肾与延误治疗、肾损伤程度、术前输血量、ISS分值、入院时平均SBP和病理肾有关联。

Objective To study the high risk factors leading to nephrectomization in blunt renal injury so as to increase the survival rate of the kidneys. Methods A retrospective analysis was done on clinical data of 226 cases with blunt renal injury admitted in Tongji Hospital from January 1992 to July 2002. Results Of all cases,153 were treated with non-operation and 73 with operation. The nephrectomy was performed in 27 cases with preoperative mean blood transfusion of 633 ml,mean injury severity score (ISS) of 39.6 and average systolic blood pressure (SBP) of 85.4 mm Hg on admission. Partial nephrectomy was performed in 12 cases with preoperative mean blood transfusion,mean ISS and average SBP on admission for 487 ml,27.8 and 99.7 mm Hg respectively. Renal repair was carried out in 34 cases with preoperative mean blood transfusion,mean ISS and average SBP on admission for 262 ml,23.6 and 112.3 mm Hg respectively. Conclusions The severity of renal injury is not related to incidence of hematuria. The nephrectomization closely correlates with the delayed treatment,the renal injury severity,the volume of preoperative blood transfusion,ISS,average SBP on admission and pathological kidneys.