药物致小儿泌尿系结石合并急性肾功能衰竭的治疗  

Treatment for pediatric urolithiasis complicated by acute renal failure caused by drugs

作　　者：杨宁宁[1] 张谦[1] 闫跃强 陈涛[1] 郭立华[1] 范应中[1] Yang Ningning;Zhang Qian;Yah Yueqiang;Chen Tao;Guo Lihua;Fan Yingzhong(Department of Pediatric Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,450052

出　　处：《中国实用医刊》2018年第19期25-27,共3页Chinese Journal of Practical Medicine

摘　　要：目的 探讨药物不合理应用导致小儿泌尿系结石合并急性肾功能衰竭的合理治疗方案.方法 收集郑州大学第一附属医院2010年12月至2015年12月收治的55例因药物不合理应用导致泌尿系结石合并急性肾功能衰竭患儿的临床资料.超声提示：双肾体积增大并呈双肾弥漫性改变,泌尿系多发结石并集合系统内絮状物质;双侧病变27例,单侧病变28例;腹部平片检查示结石均不显影.均给予解痉及碱化尿液等治疗,16例患儿联合应用血液透析治疗.结果 39例患儿经单纯解痉、碱化尿液及纠正内环境紊乱等治疗后24 h内恢复排尿,16例患儿给予1次血液透析治疗后逐渐恢复排尿.治疗1周且尿量稳定后复查彩超,51例患儿结石全部消失,4例患儿结石明显缩小,肾实质回声恢复正常,伴有肾、输尿管积水的患儿积水范围全部缩小或消失.院外随访3个月,55例患儿复查电解质、肾功能及泌尿系彩超均大致正常.结论 因不合理药物应用导致泌尿系结石合并急性肾功能衰竭的患儿应及早积极救治,联合解痉、碱化尿液治疗及维持内环境稳定的液体治疗及必要时血液透析治疗的效果理想,同时应加强对小儿用药合理性的重视.Objective To investigate the appropriate treatment protocol for children with urinary calculi complicated with acute renal failure caused by improper use of drugs .Methods Clinical data of 55 cases of pediatric urolithiasis complicated with acute renal failure caused by improper use of drugs treated in the First Affiliated Hospital of Zhengzhou University from December 2010 to December 2015 were collected . Ultrasound showed that the volume of both kidneys increased and diffuse lesions occurred;multiple stones and flocculent material emerged in the urinary tract; 27 cases had bilateral lesions , 28 cases had unilateral lesions;and the X-ray images did not display any stones .Antispasmodic and alkalized urine treatment were implemented to all the patients , of which 16 children were given hemodialysis at the same time .Results Thirty-nine children restored urination within 24 hours after simple antispasmodic , urine alkalization and correction of internal environment disorders . Sixteen children gradually restored urination after once hemodialysis treatment . One week after treatment , patients were reexamined by color ultrasound after urine became stable , and results showed that the stones were radically disappeared in 51 cases; stones were significantly reduced in 4 cases of children , and renal parenchymal echo returned to normal , areas of water accumulation disappeared for all cases accompanied by kidney or ureteral water . In the three-month follow-up outside the hospital , the electrolyte, renal function and urinary color ultrasound results were normal in all 55 cases. Conclusions The children with urolithiasis complicated with acute renal failure due to improper use of drugs should be treated as early as possible .For the pediatric utolithiasis patients , antispasmodic , alkaline urine therapy , liquid treatment to maintain the internal environment , combined with hemodialysis treatment if necessary , has ideal therapeutic effects .At the same time, we should pay more attention to pediatric medication .

关 键 词：泌尿系结石 急性肾功能衰竭 小儿 

分 类 号：R726.9[医药卫生—儿科]