肾梗死的早期诊断和治疗研究.docVIP

肾梗死的早期诊断和治疗研究 　　【摘要】 目的：分析急性肾梗死（ARI）的临床病例特点，探讨急性肾梗死的早期诊断和治疗方法。方法：回顾性分析2007-2014年本院诊断和治疗的17例ARI患者的临床资料。男12例，女5例，年龄34～69岁，平均（52.3±13.7）岁；左侧13例，右侧4例。结果：自入院到诊断明确的平均时间为（3.7±3.3）d，17例患者中有心瓣膜病和心房纤颤的13例（76.5%）；动态监测尿常规和血LDH、CT平扫+强化、CTA和经皮肾血管造影检查为其主要诊断方法。所有患者均接受抗凝治疗和/或溶栓治疗、对症治疗，15例患者出院时临床症状完全缓解，2例改善。结论：ARI的发生多与心源性疾病有关，临床表现和实验室检查缺乏特异性，早期诊断依赖泌尿科医生对ARI的认知，增强CT和CTA检查有助于早期诊断。早期抗凝治疗和/或溶栓治疗对患者均可获益。 　　【关键词】 肾梗死； 诊断； 治疗 　　【Abstract】 Objective： To analyze the clinical characteristics of patients with acute renal infarction and evaluate the early diagnosis and treatment methods of acute renal infarction. Method： The diagnosis and treatment of 17 cases with acute renal infarction from 2007 to 2014 were retrospectively analyzed. There were 12 male and 5 female patients，aged 34-69 years， mean （52.3±13.7） years， 13 left side and 4 right side. Result： The time from admission to diagnosis was （3.7±3.3）d. 13 cases of the 17 patients had artrial fibrillation or valvular heart disease history（76.5%）. The main diagnostic methods included dynamic monitoring of urinalysis and blood LDH， CT scan and enhanced CT scan of kidney， CT angiography and percutaneous renal angiography. All the patients received symptomatic treatment， anticoagnlation and /or thrombolysis treatment， symptoms were completely relieved in 15 patients， partly relieved in 2 patients. Conclusion： Acute renal infarction has been mainly associated with cardiac disease， clinical manifestations and laboratory tests lack specificity. Early diagnosis relys on urologist cognition of ARI， enhanced CT scan and CT angiography of kidney. Patients can benefit from early anticoagnlation and /or thrombolysis treatment. 　　【Key words】 Acute renal infarction； Treatment； Diagnosis 　　First-author’s address： Luoyang Central Hospital Affiliated to Zhengzhou University， Luoyang 471002， China 　　doi：10.3969/j.issn.1674-4985.2016.07.034 　　急性肾梗死（Acute renal infarction， ARI）是肾动脉或其分支急性栓塞造成肾或局部肾组织缺血性改变，由于发病率低，临床表现缺乏特异性常延迟诊断或者误诊，造成肾功能受损。本研究回顾性分析17例急性肾