超声引导下经皮肾穿刺活检术后中度肾血肿形成的危险因素分析及护理  

Risk factors for large hematoma complication caused by percutaneous renal biopsy which guided by ultrasound and related nursing care

作　　者：胡婷 张红梅[2] 殷佳珍[2] 汤绚丽[2] 张正贤[3] 王薇[1] Hu Ting;Zhang Hongmei;Yin Jiazhen;Tang Xuanli;Zhang Zhengxian;Wang Wei(Nursing Department,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Nephrology,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,China;Department of Ultrasound,Hangzhou Hospital of Traditional Chinese Medicine,Hangzhou 310007,China)

机构地区：[1]浙江大学医学院附属第一医院护理部,杭州310003 [2]杭州市中医院肾病科,310007 [3]杭州市中医院超声科,310007

出　　处：《中国实用护理杂志》2019年第29期2263-2268,共6页Chinese Journal of Practical Nursing

摘　　要：目的分析超声引导下经皮肾穿刺活检术(PRB)后中度肾血肿形成的危险因素,为临床早期防范及实施有效护理提供依据。方法回顾性分析2016年1月至2017年1月在杭州市中医院肾病科住院行PRB的707例患者临床资料,通过单变量分析、共线性诊断、主成分分析、多变量分析及工作特征曲线(ROC曲线)分析PRB后中度肾血肿形成的危险因素。结果PRB后肾血肿发生率为86.1%(609/707),其中轻度血肿占78.9%(558/707)、中度血肿占7.2%(51/707)、无重度出血患者。对PRB后51例中度血肿患者危险因素单变量分析发现,患者肾小管间质纤维化、新月体>25%、血肌酐、高血压病史、PRB前收缩压、舒张压及平均动脉压(均值)差异均有统计学意义(P<0.05)。多变量分析发现中度血肿患者PRB前血压更高(OR=1.414,95%CI=1.007~1.985,P=0.045),中度血肿有高血压病史的患者更多(OR=1.997,95%CI=0.995~4.009,P=0.052)。PRB前血压及高血压病史共同预测PRB后中度肾血肿形成的ROC曲线下面积为0.634,约登指数为0.27。PRB前血压及高血压病史单独预测中度肾血肿形成的约登指数分别为0.28、0.22(P>0.05)。结论高血压病史及PRB前血压是PRB后中度肾血肿形成的独立危险因素。有高血压病史的患者发生中度肾血肿的可能性高于无高血压史者;PRB前血压越高者发生中度肾血肿的可能性越高。高血压史及PRB前血压预测PRB后中度肾血肿形成具有一定的效果。两者单独对PRB后中度血肿形成均具有一定的预测性,预测效果PRB前血压有优于高血压史的趋势。Objective To analyze the risk factors for large renal hematoma caused by percutaneous renal biopsy (PRB) in order to provide evidence for early clinical prevention and Effective nursing. Methods The data of 707 patients who underwent PRB in nephrology department in Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to January 2017 were retrospectively identified. Demographic and clinical data were collected, including general status (gender, age, body mass index, histological diagnosis, associated diseases), laboratory indexes and related examination during PRB (serum creatinine, estimated glomerular filtration rate, creatinineclearance rate, serumuricacid, serumalbumin, hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, kidney size), blood pressure(history of hypertension, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure before PRB). Univariable logistic regression analysis, linear diagnosis, factor analysis, multivariable logistic regression analysis and receiver operating characteristic curve (ROC curve) were used to assess risk factors. Results Over the period, 707 native kidney biopsies were performed. Hematoma occurred in 609 biopsies (86.1%), including 558 minorhematomacases (78.9%), 51 largehematoma cases (7.2%), no severe complications were observed. Univariable logistic regression analysis of risk factors in 51 patients with large hematoma after PRB found that there were significant differences in renal tubulointerstitial fibrosis, crescents > 25%, serum creatinine, history of hypertension, systolic blood pressure, diastolic blood pressure and mean arterial pressure before PRB (P< 0.05). Compared with the non-hematoma/minor-hematoma group, the blood pressure before PRB increased significantly in large hematoma group (OR=1.414, 95%CI=1.007-1.985, P=0.045). More patients with a history of hypertension in large hematoma group (OR=1.997, 95% CI=0.995-4.009, P=0.052).The area under the ROC curve for predicting large hematoma

关 键 词：肾穿刺活检 中度肾血肿 危险因素 

分 类 号：R473.6[医药卫生—护理学]