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目的:探讨严重肾损伤的有效诊疗措施,以期提高抢救成功率。方法:回顾性分析2006年1月～2011年12月收治的严重肾损伤患者106例的临床资料,其中Ⅲ级33例,Ⅳ级62例,Ⅴ级11例。以48小时为时间观察点,观察患者的尿液颜色、生命体征、血红蛋白变化情况,结合彩超、CT结果,根据情况决定手术抑或保守治疗。结果:保守治疗成功41例,成功率38.7%;45例行肾切除,切除率42.5%。肾切除组收缩压、血红蛋白分别下降(46.0±13.1)mmHg和(3.9±0.7)g,而非肾切除组下降(22.0±8.3)mmHg和(2.0±0.5)g,两组比较差以有统计学意义(P<0.01)。本组患者明显血尿59例,彩超检查诊断准确率为52.8%(56例),CT准确率为97.2%(103例),两组比较差异有统计学意义(χ2=55.6,P<0.01)。结论:血尿与肾损伤严重程度不一致,血压、血红蛋白下降情况才是判断肾损伤严重程度的重要指标;CT可作为肾损伤分级及是否手术的重要依据;血压/血红蛋白进行性下降是手术探查的绝对指征。
Objective: To explore effective diagnosis and treatment of severe renal injury, with a view to improve the success rate of rescue. Methods: The clinical data of 106 patients with severe renal injury admitted in our hospital from January 2006 to December 2011 were retrospectively analyzed. Among them, 33 cases were grade Ⅲ, 62 cases were Ⅳ and 11 cases were Ⅴ. 48 hours for the time to observe the point of observation of the patient’s urine color, vital signs, hemoglobin changes, combined with color Doppler ultrasound, CT results, depending on the circumstances decided surgery or conservative treatment. Results: The conservative treatment was successful in 41 cases, the success rate of 38.7%; 45 cases of nephrectomy, resection rate of 42.5%. In the nephrectomy group, systolic blood pressure and hemoglobin decreased (46.0 ± 13.1) mmHg and (3.9 ± 0.7) g, respectively, while those in the non-nephrectomy group decreased by (22.0 ± 8.3) mmHg and (2.0 ± 0.5) Significance (P <0.01). The group of patients with hematuria in 59 cases, the diagnostic accuracy of color Doppler ultrasound was 52.8% (56 cases), CT accuracy was 97.2% (103 cases), the difference between the two groups was statistically significant (χ2 = 55.6, P <0.01). Conclusion: The severity of hematuria is different from the severity of renal injury, and blood pressure and hemoglobin decrease are important indicators to judge the severity of renal injury. CT can be used as an important basis for the grading of renal injury and whether the surgery is performed. The blood pressure / hemoglobin decrease is the absolute value of surgical exploration Indications.