婴幼儿三聚氰胺相关泌尿系结石并发急性肾衰竭诊疗分析  

Melamine related urinary calculus and acute renal failure in infants

作　　者：孙宁[1] 沈颖[2] 孙嫱[2] 李旭冉[1] 贾立群[3] 张桂菊[2] 张潍平[1] 陈植[2] 樊剑锋[2] 蒋也平 冯东川 张锐锋 朱孝宇 肖宏展[6] 

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科,100045 [2]首都医科大学附属北京儿童医院肾脏内科 ,100045 [3]首都医科大学附属北京儿童医院影像科 ,100045 [4]徐州市儿童医院外科 [5]徐州市儿童医院内科 [6]北京微量化学研究所

出　　处：《中华儿科杂志》2008年第11期810-815,共6页Chinese Journal of Pediatrics

摘　　要：目的探讨食用受三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石并发急性肾衰竭患儿的临床特点、诊断和治疗措施。方法回顾性分析首都医科大学附属北京儿童医院和徐州市儿童医院2008年收治的34例因食用三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石、梗阻发生急性肾衰竭的患儿。分析其流行病学、临床表现及影像学特点，总结4种不同的治疗方法及疗效。结果34名患儿均存在急性肾衰竭，血尿素氮（24．1±8．2）mmol／L，血肌酐（384．2±201．2）μmol／L。对留取的14例结石标本分析证实，结石是三聚氰胺和尿酸的合成体。膀胱镜治疗组血肌酐降至正常的平均时间为（3．5±1．9）d；切开取石组（2．7±1．1）d；透析组（3．8±2．3）d；内科保守治疗组（2．7±1．6）d。四组。肾功能恢复时问差异无统计学意义（P=0．508），组间差异无统计学意义（P=0．803—1）。经治疗34例患儿急性肾衰竭全部治愈，泌尿系结石完全或部分排出。肾功能恢复时间为（3．0±1．8）d。结论三聚氰胺污染婴幼儿配方奶粉可以导致婴幼儿泌尿系结石引发的梗阻性急性肾衰竭，治疗首选药物或透析方法纠正电解质紊乱，特别是高钾血症，尽快通过内、外科方法解除梗阻引流尿液。患儿近期预后良好。Objective To summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk. Methods Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children＇s Hospital affiliated to the Capital Medical University and the Xuzhou Children＇s Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, image features as well as effects of 4 types of therapies. Results All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen （BUN） was （24. 1 ± 8.2）mmol/L and creatinine （Cr） was （384.2 ±201.2）μmol/L. The chemical analysis on the urinary calculus sampled from 14 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was （3.5 ±1. 9） d for eystoscopy group, （2.7 ± 1.1 ） d for lithotomy group, （3.8 ± 2. 3 ） d for dialysis group, and （2, 7± 1.6 ） d for medical treatment group, which had no statistically significant difference （ P = 0. 508 ）. Renal failure of all the 34 infants was rerelieved within 1 to 7 days, averaging （3.0± 1.8） d. Conclusion Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbances, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as possible. It is observed that the short term prognosis is satisfactory.

关 键 词：结石 泌尿系疾病 肾功能衰竭 急性 三聚氰胺 婴幼儿 

分 类 号：R686[医药卫生—骨科学]