摘要
目的探讨急性肾梗死的早期诊断和介入治疗方法。方法回顾性分析5例急性肾梗死患者的诊治情况。男4例，女1例，年龄38～68岁，以腰部剧痛或上腹胀痛就诊，多伴有恶心、呕吐。就诊时间1～16h。患者多有风湿性心脏病、心房纤颤病史。化验血白细胞（8．9～15．8）×10^9／L，尿红细胞-～＋＋＋，蛋白＋～＋＋＋，血肌酐66～216μmol／L，乳酸脱氢酶350～920U／L。多普勒超声和CT检查提示大面积肾梗死3例，局灶性肾梗死2例，应用经皮股动脉穿刺置管行血管造影及溶栓、导管抽吸血栓等治疗。结果1例局灶肾梗死和1例肾动脉栓塞注射尿激酶直接溶栓成功，1例局灶肾梗死注射rt—PA溶栓成功，2例发病时间较长的肾动脉栓塞患者行血栓抽吸后配合再次注射rt—PA溶栓成功。术后4例获随访，随访时间3～12个月，血肌酐较术前下降（53～122μmol／L），CT或三维CT血管造影提示患侧肾动脉及分支通畅，梗死区域血供接近正常。结论对急性肾梗死患者的早期诊断和介入治疗效果满意。三维CT血管造影有助于早期诊断和随访。对较大血栓行导管抽吸＋溶栓可提高治疗效率。
Objective To discuss the early diagnosis and interventional therapy of acute renal in- farction. Methods The diagnosis and therapy of 5 cases of acute renal infarction were retrospectively ana- lyzed. There were 4 male and 1 female patients, aged 38 - 68 years. The symptoms were severe back pain or upper abdominal pain, with or without nausea and vomiting and the time to hospital was 1 to 16 h. Four ca- ses had rheumatic heart disease and 4 cases had artrial fibrillation history. The lab assay results： WBC 8.9-15.8 ×109/L, urine RBC - to ＋ ＋ ＋, albumin ＋ to ＋ ＋ ＋, serum creatinin 66-216 μmol/L, serum LDH 350 - 920 U/L. The doppler ultrasound and CT scan showed large infarction in 3 cases and focal infarction in 2 cases. Percutaneous arteriography, thrombolytie therapy and thrombosuction via catheter were applied promptly. Results The 5 cases were diagnosed and treated timely and effectively. The emboli were cleared. Four patients were followed up for 3 - 12 months. The creatinin recovered to 53 - 122 μmol/L, and the blood perfusion of the infarction lesion was satisfactory. Conclusions Early diagnosis and interventional therapy is important for achieving satisfactory recovery of the acute renal infarction. Three dimensional CT angingraphy could conduce to early diagnosis and follow-up. Thrombosuction via catheter plus thrombolytic therapy is efficient for greater embolus.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第11期851-855,共5页
Chinese Journal of Urology
关键词
肾梗死
诊断
溶栓
介入治疗
Renal infarction
Diagnosis
Thrombolytic therapy
lnterventional therapy
