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目的研究梗阻性急性肾功能衰竭的原因以及相应的急救措施。方法选择2010年3月—2012年9月诊治的118例梗阻性急性肾功能衰竭的患者,对其发生病因进行研究,同时研究进行急救措施(具体包括:皮肾穿刺造瘘术、输尿管插管术、输尿管切开术以及肾造瘘术等)的临床效果。结果泌尿系统结石导致梗阻的患者有73例,占61.9%;16例是由肿瘤压迫输尿管或者侵润局部组织,占13.6%;15例患者是由前列腺增生和泌尿系统结核导致的梗阻,占12.7%。经过积极的治疗,89例患者成功解除梗阻,有效率75.4%,7例患者在1周内死亡。对这109例梗阻性急性肾衰竭患者进行输尿管插管,有65例患者的梗阻现象成功解除,而且引流通畅,通过治疗后患者的梗阻现象消失,肾功能有所缓解。通过皮肾穿刺造瘘术的24例患者,梗阻现象均明显缓解,经过治疗后的7d,血尿素氮及血肌酐指标明显降低。结论梗阻性急性肾功能衰竭最多见的原因即为泌尿系结石,其次为恶性肿瘤,再次为结核,之后为前列腺增生。在对其进行治疗时首先必须解决的是梗阻现象,主要方法为输尿管插管引流术。如插管失败后,可选择经皮穿刺造瘘术等各种微创手术,如仍失败,最终考虑开放式手术。
Objective To study the causes of obstructive acute renal failure and the corresponding emergency measures. Methods A total of 118 patients with obstructive acute renal failure diagnosed and treated from March 2010 to September 2012 were enrolled in this study. The etiology of the patients with obstructive acute renal failure was studied, and the first aid measures (including the nephrostomy, ureteral intubation, Surgery, ureterotomy and nephrostomy, etc.) clinical effect. Results Urolithiasis caused obstruction in 73 cases, accounting for 61.9%. Twenty-six of the 16 cases were tumor-compressed ureter or infiltration of local tissues, accounting for 13.6%. Fifteen patients were obstructed by benign prostatic hyperplasia and urinary tract tuberculosis, accounting for 12.7% %. After active treatment, 89 patients successfully relieve the obstruction, the effective rate was 75.4%, 7 patients died within 1 week. Of 109 patients with obstructive acute renal failure ureteral intubation, 65 patients successfully obstruction of the phenomenon, and drainage, obstruction by the disappearance of patients after treatment, renal function eased. Twenty-four patients who underwent percutaneous nephrostomy were significantly relieved of obstruction. After 7 days of treatment, blood urea nitrogen and serum creatinine were significantly decreased. Conclusions The most common cause of obstructive acute renal failure is urinary calculi, followed by malignant tumors, tuberculosis again, followed by benign prostatic hyperplasia. In the treatment of the first thing that must be addressed is obstruction, the main method for ureteral intubation drainage. Such as intubation fails, you can choose percutaneous ostomy and other minimally invasive surgery, if still fails, and ultimately consider open surgery.