先天性肾脏和尿路畸形患儿的诊疗、转诊及随访管理体系的研究  

Study on the management system for the treatment,referral and follow-up of children with congenital anomalies of kidney and urinary tract

作　　者：郑丽霞 孙书丽 ZHENG Lixia;SUN Shuli(Department of Pediatrics,Quzhou Maternal and Child Health Hospital,Quzhou 324000,Zhejiang,China;Department of Neonatology,Quzhou Maternal and Child Health Hospital,Quzhou 324000,Zhejiang,China)

机构地区：[1]衢州市妇幼保健院儿内科,浙江衢州324000 [2]衢州市妇幼保健院新生儿科,浙江衢州324000

出　　处：《中国现代医生》2023年第17期29-32,36,共5页China Modern Doctor

基　　金：衢州市科技计划指导性项目(2020111)。

摘　　要：目的筛查和随访妊娠期发现有先天性肾脏和尿路畸形(congenital anomalies of kidney and urinary tract,CAKUT)患儿的情况,探讨CAKUT泌尿系统超声筛查、转诊(妇幼保健院–儿童专科医院)体系实施的可行性。方法选取2019年3月至2020年2月在衢州市妇幼保健院孕检时发现、确诊且能随访到的100例CAKUT患儿作为对照组,选取2020年3月至2021年2月在医院孕检时发现、确诊且同意在衢州市妇幼保健院进行诊疗转诊随访管理的100例CAKUT患儿设为观察组。比较两组患儿的CAKUT类型分布情况,以及随访3个月、1年后两组患儿肾盂扩张情况、尿流动力学指标情况及肾功能。结果两组患儿的CAKUT类型比较,差异无统计学意义(P>0.05)。随访3个月后,观察组的肾盂扩张恢复正常率和好转率均显著高于对照组(P<0.05);随访1年后,观察组的肾盂扩张恢复正常率显著高于对照组(P<0.05),残余尿量(residual urine volume,RUV)水平显著低于对照组(P<0.05)。在随访3个月和1年后,血清尿素氮(blood urea nitrogen,BUN)、肌酐(serum creatinine,SCr)、24h尿蛋白(24 hours urine protein,24hUP)水平均低于对照组,最大尿流率(the maximum flow rate,Qmax)水平、血肌酐清除率(creatinine clearance rate,Ccr)均高于对照组,差异均有统计学意义(P<0.05)。结论CAKUT患儿以单纯肾盂扩张为主要类型,诊疗转诊随访管理下患儿能够获得较佳恢复,基层医院建立CAKUT患儿的诊疗转诊随访管理体系有实际意义。Objective To screen and follow up children with congenital anomalies of kidney and urinary tract(CAKUT)detected during pregnancy,and to explore the feasibility of implementing the CAKUT urological ultrasound screening and referral(Maternal and Child Health Centre-Children’s Specialist Hospital)system.Methods A total of 100 children with CAKUT who were detected and diagnosed during pregnancy check-ups at Quzhou Maternal and Child Health Hospital from March 2019 to February 2020 and could be followed up were selected as the control group,and 100 children with CAKUT who were detected and diagnosed during pregnancy check-ups at Quzhou Maternal and Child Health Hospital from March 2020 to February 2021 and agreed to be treated and referred for follow-up management were selected as the observation group.The distribution of CAKUT types was compared between the two groups,and the renal pelvis dilatation,urodynamic parameters and renal function were compared between the two groups after 3 months and 1 year of follow-up.Results There was no statistically significant difference in the type of CAKUT between the two groups of children(P>0.05).After 3 months of follow-up,the rate of normalization and improvement of renal pelvis dilatation were significantly higher in the observation group than those in the control group(P<0.05).After 1 year of follow-up,the rate of return to normal renal pelvis dilatation was significantly higher in the observation group than that in the control group(P<0.05)and the residual urine volume(RUV)level was significantly lower than that in the control group(P<0.05).After 3 months and 1 year of follow-up,serum urea nitrogen(BUN),creatinine(SCr)and 24-hour urine protein(24hUP)were lower in the observation group than those in the control group.The maximum flow rate(Qmax)level and creatinine clearance rate(Ccr)were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusions Simple pyelomegatasis is the main type of CAKUT children.Children with diagnosi

关 键 词：先天性肾脏和尿路畸形 诊疗转诊随访管理 肾盂扩张 

分 类 号：R714.5[医药卫生—妇产科学]