肾脏损伤292例回顾与总结  

Renal Injury:Review of 292 Cases

作　　者：赵跃华[1] 刘显福[1] 宋连艳 

机构地区：[1]北京市顺义区医院泌尿外科,101300

出　　处：《医学研究杂志》2007年第5期89-91,共3页Journal of Medical Research

摘　　要：目的分析引起肾脏损伤的原因，以及如何对肾脏损伤做出诊断和分级；评估各级肾脏损伤的治疗措施与损伤分级的关系。方法回顾性地总结各种肾脏损伤病人292例，均详细记录损伤原因，行尿液常规、血液常规检查，CT平扫检查，如果出现肾周血肿则进行增强扫描，根据损伤范围按照AAST的损伤分类将肾脏损伤分为5级。其中Ⅰ～Ⅲ级为轻度损伤；Ⅳ级以上为重度损伤。持续低血压及血球压积持续走低的病人，急行手术探察。行肾修补术或肾切除术。结果292例病人Ⅰ-Ⅴ级分别为：Ⅰ级：176例；Ⅱ级：50例；Ⅲ级：31例；Ⅳ级：22例；Ⅴ级：13例。钝性损伤占98．97％，其中车祸占73．63％；刀刺伤3例，占1．03％。Ⅳ级以上肾脏损伤全部由于车祸或刀刺伤引起。轻度（Ⅰ～Ⅲ级）占88％；重度（Ⅳ～Ⅴ级）占12％。重度损伤病人中，15例行肾切除术。结论机动车车祸是造成肾脏损伤的最主要原因。正确的诊断和精确的分级，是治疗肾脏损伤的关键。对于重度肾脏损伤的病人在抗休克治疗后血压仍不稳和无法纠正贫血时，采取急诊手术探察或直接行肾切除术。Objective To Analysis and determine the causes of renal injury, and how to make a diagnosis and grade renal injury; evaluating the relations between renal injury grade and treatment measures. Methonds We retrospectively reviewed the records of all patients who hospitalized with renal injury from June. 1996 to Dec. 2002. total 292 cases were reviewed. All patients were evaluated with computed tomography（CT） and classified into Grade Ⅰ to Grade Ⅴ. according to Injury Organ Scale of American Association of Surgery of trauma （AAST） minor renal injury included grade Ⅰ - grade Ⅲ, and major renal injury, grade Ⅳ and grade Ⅴ. patients with renal injury of persistent hypotension and anemia needed a surgical exploration immediately after anti - shock ts. Results Of 292 cases evaluated , 176 were grade Ⅰ; 50 grade Ⅱ; 31 grade Ⅲ; 22 grade Ⅳ and 13 grade Ⅴ respectively. Motor accidents are the most major causes of renal injury（73.63% ）. 88% patients were minor renal injury（ Grade Ⅰ - Ⅲ ） ; and 12% were major renal injury（ Grade Ⅳ - Ⅴ ）. all patients with minor renal injury were successfully treated with conservative therapy ; however, 15 cases with major renal injury underwent nephrectomy. Conclusions Motor accidents are the most major causes of renal injury. Right diagnosis and precise classification to renal injury are critical to management. Patients with minor renal injuries were treated by conservative observation ; but patients with major renal injury of persistent hypotension and anemia needed a surgical exploration immediately after anti - shock measurements ; major patients with grade Ⅳ were successfully treated with conservative therapy; however, patients with grade Ⅴ required nephrectomy in majority.

关 键 词：肾脏 损伤 血尿 肾切除术 

分 类 号：R692[医药卫生—泌尿科学]