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1.
目的探讨头孢曲松钠使用不当致小儿泌尿系统结石、急性肾功能衰竭的可行性治疗方案。方法选取2013年6月到2015年12月因头孢曲松钠使用不当致小儿泌尿系结石、急性肾功能衰竭患儿8例,回顾性分析其临床资料。8例患儿均采用解痉、碱化尿液、保护肾脏以及消炎等基础性治疗,8例患儿中7例采用膀胱镜下输尿管逆行插管冲洗术治疗,1例患儿因经膀胱镜下输尿管逆行插管冲洗术治疗失败,转为采用腹膜透析治疗。结果治疗后24 h,8例患儿结石完全消失6例;结石残留且结石直径5 mm者2例,经枸橼酸氢钾钠治疗1个月,残留结石完全消失。8例患儿中肾、输尿管积水症状改善效果,优5例,良2例,差1例。结论常规药物治疗联合输尿管逆行插管冲洗术或腹膜透析,可有效清除结石,缓解肾、输尿管积水症状,改善患儿预后。  相似文献   

2.
双侧输尿管结石并梗阻性无尿的急诊处理   总被引:1,自引:0,他引:1  
目的:比较不同手术方法急诊处理双侧输尿管结石并梗阻性无尿的疗效.方法:回顾性分析59例因双侧输尿管结石急性梗阻并梗阻性无尿急诊入院患者的临床资料,比较急诊输尿管镜碎石与膀胱镜下逆行插管引流解除梗阻的成功率、肾功能恢复及并发症发生情况.结果:输尿管镜碎石组解除梗阻的成功率为100%,而膀胱镜下逆行插管组成功率仅为70.8%;术后1周输尿管镜碎石组肾功能完全恢复正常者占85.7%.膀胱镜下逆行插管成功患者中肾功能完全恢复正常者占83.3%;两组病例手术均无输尿管断裂、梗阻性脓肾等重大并发症发生.结论:双侧输尿管结石并梗阻性无尿选择输尿管镜治疗是一种适宜的腔内手术方法,创伤少、成功率高,并可在解除梗阻的同时清除结石.  相似文献   

3.
目的:总结三聚氰胺污染奶粉致婴幼儿泌尿系结石(三聚氰胺结石)并发急性肾衰竭(ARF)的治疗体会.方法:我院泌尿外科2008年6-10月共收治三聚氰胺结石123例,其中14例发生肾后性ARF.14例均在入院后4-6小时确诊,及时纠正电解质紊乱,积极行输尿管镜双J管置入术冲洗或碎石治疗,其中13例急诊手术,1例因外院行双J管置入术后肾周感染积液而先期行肾周穿刺引流,生命体征平稳后1周再行输尿管镜下碎石、双J管置入术.结果:11例上尿路梗阻于输尿管镜下以碱性药物肾盂冲洗迅速解除梗阻,成功置入双J管;3例下尿路尿道结石经输尿管镜将结石推入膀胱碎石,解除梗阻.14例术后3日肾功能恢复正常,复查B超示肾孟积水、输尿管扩张及结石均消失,随访2个月未见异常.结论:输尿管镜下碱性药物肾孟灌洗及经尿道双J管置入术治疗婴幼儿肾后性ARF安全、有效.  相似文献   

4.
肾后性急性肾功能衰竭51例急诊微创治疗体会   总被引:3,自引:0,他引:3  
目的总结并探讨急诊微创治疗肾后性急性肾功能衰竭的安全、有效方法。方法对51例不同梗阻原因致肾后性急性肾功能衰竭的患者,采用急诊输尿管镜下钬激光碎石并置管引流(12例)、膀胱镜下逆行双J管插管(29例)、膀胱镜下逆行双J管插管联合经皮肾穿刺造瘘引流(10例)解除梗阻,回顾性分析其治疗效果。结果51例患者均急诊成功解除尿路梗阻。无1例死亡,无尿瘘、输尿管穿孔和肾出血等并发症。结论上尿路梗阻是肾后性急性肾功能衰竭的主要原因,如能明确是结石引起的肾后性肾功能衰竭,应首选输尿管镜下钬激光碎石并置管引流;如不能明确,膀胱镜下逆行插管和经皮肾穿刺造瘘引流也是可行的急诊有效方法。  相似文献   

5.
目的 了解受三聚氰胺污染的婴幼儿配方扔粉致婴幼儿泌尿系结石急、重症的临床特点,总结其诊治经验.方法 回顾性分析28例三聚氰胺致婴幼儿泌尿系结石急、重症的临床资料.结果 行膀胱镜留置输尿管支架管术17例(60.71%),行开放手术取石术5例(17.86%),行导尿、利尿、消炎、解痉治疗4例(14.28%),行膀胱镜留置输尿管支架管术后再行开放手术取石2例(7.14%).出院时,23例患儿肾输尿管结石完全消失,5例有结石残留,其中3例患儿肾结石、肾积水或存在单侧输尿管结石从而术后再次发生尿路梗阻.结论 三聚氰胺致婴幼儿泌尿系结石可早期形成及发病,急、重症以无尿、少尿、排尿困难为主要临床表现,超声检查是最简便的检查,CT能进一步明确结石的部位和积水程度,膀胱镜留置输尿管支架管效果明显、创伤小.  相似文献   

6.
目的:探讨阿昔洛韦导致的急性肾衰竭(ARF)的临床特征,提高相应的预防和治疗水平.方法:回顾性研究我科10年来收治的阿昔洛韦所致ARF临床资料.结果:(1)患者各年龄均有发病,平均年龄38.4±17.8岁,在用药5d内起病,为速发型;(2)临床表现以腰痛、腰胀,恶心、呕吐,蛋白尿,镜下血尿为主,急性肾功能衰竭主要表现为非少尿型(占80%),平均血肌酐水平(Scr) 417 ± 117 μmol/L;(3)患者均予以停用阿昔洛韦、水化、碱化尿液等常规对症处理,其中3例少尿型ARF患者行血液透析治疗;肾功能于3~15天内完全缓解(Scr <133 μmol/L). 结论:阿昔洛韦导致的ARF以非少尿型为主,腰痛腰胀是其突出的临床特征;患者经停药、水化、碱化尿液等积极治疗后预后良好,其中少尿型ARF,病情较重,建议血液透析;规范合理用药是预防的关键.  相似文献   

7.
总结输尿管镜技术成功救治13例因喂养三聚氰胺污染奶制品导致双肾结石合并急性肾衰婴儿的护理经验.在输尿管镜下放置双"J"管,解除梗阻,恢复肾功能,在术前对患儿家属进行心理护理和严格液体管理,术后针时膀胱痉挛和多尿期进行护理,保证了患儿的顺利康复.本组13例患儿均未发生护理并发症.  相似文献   

8.
上尿路结石梗阻致急性肾衰竭41例治疗体会   总被引:1,自引:1,他引:0  
林宇峰  李杰贤  黄国标 《新医学》2006,37(8):525-526
目的:总结上尿路结石梗阻致急性肾衰竭急诊治疗经验.方法:对41例上尿路结石梗阻致急性肾衰竭的临床资料进行回顾性分析.结果:41例中29例经急诊逆行插管引流尿液后,行输尿管镜下气压弹道碎石术,26例直接碎石成功,3例将结石推回肾脏后碎石成功;12例B超下肾穿刺微造瘘,引流尿液3~4日,病情平稳后行输尿管镜下气压弹道碎石术,碎石成功率为100%.术中及术后均无严重并发症.29例肾功能恢复正常,9例血尿素氮、血清肌酐明显下降,肾功能接近正常,总有效率为93%(38/41);2例原合并感染者肾功能无改善,1例双肾多发结石合并重度肾积水伴左心衰竭、消化道大出血患者放弃治疗.结论:输尿管镜下逆行插入输尿管导管或双J管,或B超引导下经皮肾穿刺微造瘘是安全有效引流尿液的方法.输尿管镜下气压弹道碎石术安全、有效,可作为治疗上尿路结石梗阻致急性肾衰竭的首选方法.  相似文献   

9.
目的:尿瘘作为肾移植后早期最常见的外科并发症发生率可高达3%~10%,处理不当容易致移植肾丢失.文章回顾性分析肾移植后并发球瘘临床资料,结合文献总结其处理经验.方法:选择解放军广州军区广州总医院2000-12/2009-03肾移植1 203例中发生尿瘘忠者27例,接受尸体供肾26例,活体供肾1例,男16例,女11例,平均年龄43岁.所有患者确定为尿瘘后先采取留置18Fr双腔气囊导尿管治疗,如果效果不好可采用手术探查.17例采用保守治疗,其中12例单纯伤口引流+留置膀胱18Fr导尿管双向引流,5例经膀胱镜逆行置入输尿管支架+留置膀胱18Fr导球管;10例进行开放手术探查,其中5例行移植肾输尿管与膀胱重新吻合术+置入输尿管支架,5例开放手术移植肾输尿管与自体输尿管端端吻合+置入输尿管支架,开放于术中有6例加用带蒂大网膜包绕于吻合口.结果:移植后因再次尿瘘而行手术损伤肾静脉切除移植肾1例,26例尿瘘治愈,随访3个月~7年,无再发尿瘘、吻合口狭窄、移植肾无积水及尿路感染,肾功能正常.结论:对丁肾移植后尿瘘应早诊断、早治疗,可先采取保守治疗,大多数忠者可以治愈,无效后及时采取手术干预,对于复杂性的尿瘘于吻合口处可采用带蒂大网膜包绕提高手术成功率.  相似文献   

10.
目的 探讨因食用问题奶粉所致的梗阻性肾功能衰竭患儿的护理.方法 回顾性总结21例因食用问题奶粉所致的梗阻性肾功能衰竭患儿的治疗方法、饮食宜忌、病情观察,尤其是尿液监测的重点、患儿体位以及腹膜透析和血液透析的护理.结果 21例患儿均于入院后1~3 d泌尿道梗阻解除,肾功能逐渐恢复正常.结论 三聚氰胺污染而产生的尿酸胺结石的结构较为疏松,经碱化尿液、增加液体摄人、经常更换体位等,结石易于自行排出;给予适宜的饮食,并通过监测尿pH,保持尿pH在6.5~6.8,可避免尿路结石增大、增多而影响其溶解和排出.  相似文献   

11.
BACKGROUND: Peritoneal dialysis (PD) is still widely used for acute renal failure (ARF) in developing countries despite concerns about its inadequacy. Continuous PD has been evaluated in ARF by analyzing the resolution of metabolic abnormality and normalization of plasma pH, bicarbonate, and potassium. Methodology: A prospective study was performed on 30 ARF patients who were assigned to high-dose continuous PD (Kt/V = 0.65 per session) via a flexible catheter (Tenckhoff) and automated PD with a cycler. Fluid removal, pH and metabolic control, protein loss, and patient outcome were evaluated. RESULTS: Patients received 236 continuous PD sessions; 76% were admitted to ICUs. APACHE II score was 32.2+/-8.65. BUN concentrations stabilized after 3 sessions, creatinine after 4, and bicarbonate and pH after 2. Fluid removal was 2.1+/-0.62 L/day. Creatinine and urea clearances were 15.8+/-4.16 and 17.3+/-5.01 mL/minute respectively. Normalized creatinine clearance and urea Kt/V values were 110.6+/-22.5 L/week/1.73 m(2) body surface area and 3.8+/-0.6 respectively. Solute reduction index was 41%+/-6.5% per session. Serum albumin values remained stable in spite of considerable protein losses (median 21.7 g/day, interquartile range 9.1-29.8 g/day). Regarding ARF outcome, 23% of patients presented renal function recovery, 13% remained on dialysis after 30 days of follow-up, and 57% died. CONCLUSION: High-dose continuous PD by flexible catheter and cycler was an effective treatment for ARF. It provided high solute removal, allowing appropriate metabolic and pH control, and adequate dialysis dose and fluid removal. Continuous PD can therefore be considered an alternative to other forms of renal replacement therapy in ARF.  相似文献   

12.
腹膜透析在小儿心脏术后急性肾功能衰竭治疗中的应用   总被引:7,自引:0,他引:7  
目的探讨心脏直视术后急性肾功能衰竭的治疗方法。方法1995年4月~2000年5月,应用腹膜透析治疗小儿急性肾功能衰竭6例,急性肾功能衰竭均发生于低温体外循环下复杂先天性心脏病矫正术后,原因包括心跳骤停1例,低心排出量综合征4例,诱因不明1例。结果死亡1例。存活5例腹膜透析3~4日尿量恢复正常,透析出液体(42±18)ml  相似文献   

13.
Peritoneal dialysis for management of pediatric acute renal failure.   总被引:4,自引:0,他引:4  
BACKGROUND: While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention. DESIGN: Retrospective database review of children requiring PD for ARF over a 10-year period. SETTING: Pediatric intensive care unit at a tertiary-care referral center. PATIENTS: Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF. RESULTS: Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome (13), sepsis (10), nonrenal organ transplant (7), malignancy (3), and other (3). Mean duration of PD was 11 +/- 13 days. Children with ARF were younger (30 +/- 48 months vs 88 +/- 68 months old, p < 0.0001) and smaller (11.9 +/- 15.9 kg vs 28 +/- 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percutaneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease (p < 0.0001). Hypotension was common in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%. CONCLUSIONS: Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.  相似文献   

14.
总结床边置管腹膜透析(PD)治疗特殊人群急性肾功能衰竭(ARF)的临床护理.PD过程各环节的精心护理和对病人或家属详细的宣教,是确保PD顺利进行的前提,是提高ARF抢救成功率的关键.  相似文献   

15.
血液净化技术在ICU急性肾功能衰竭的应用   总被引:3,自引:0,他引:3  
目的:探讨ICU复杂性急性肾功能衰竭(ARF)血液净化治疗模式的选择及疗效和并发症。方法:回顾性分析1999年1月-2001年12月在我院ICU收治的20例ARF患的血液净化治疗情况。比较不同治疗模式的疗效的并发症。结果:5例接受普通间歇性血液透析(IHD)治疗。3例治愈,2例死亡。血尿素氮(BUN)、肌酐(Cr)和血钾透析后均明显下降,但透析间期波动大。补充的液体量受限制。2例透析后出现严重的并发症并死亡。13例行连续性肾脏替代治疗(CRRT),血BUN、Cr和血钾缓慢下降,波动小,并能持续于较低水平。允许补充大量液体和静脉营养。CRRT还能改善血流动力学状态,不加重脑水肿患的意识障碍。2例急性重症胰腺炎合并高乳糜微粒血症的ARF患接受非选择性血浆置换(PE)加CRRT治疗,胰腺炎得以较快控制,肾功能逐渐恢复。结论:对于ICU的重症ARF患,选择IHD应慎重。CRRT更适合复杂性ARF的肾替代治疗。血浆置换联合CRRT可能是治疗急性重症腺合并高脂血症的ARF患的有效方法。  相似文献   

16.
PURPOSE: To investigate the incidence and the main pre-operative risk factors for the development of acute renal failure (ARF) in triple vessels coronary artery bypass grafting (CABG) with special reference to a subset of patients with poor cardiac function (ejection fraction <50%). PATIENTS: The study included the patients (n = 66) requiring CABG from January 1, 1995 to January 1, 2002 in a medical center. RESULTS: A high percentage (84.8%) of patients developed ARF and 57.6% of patients received hemodialysis (HD). Preoperative variables significantly associated with the development of ARF included increased age, increased preoperative serum creatinine, decreased preoperative 24-hour urine output and accepted emergent CABG. By the logistic multivariate regression model, increased age (OR = 1.16), preoperative serum creatinine (OR = 3.58,), decreased preoperative 24-hour urine amount (OR = 0.99,) and emergent CABG (OR = 2.01) were independently associated with ARF. As for the need for HD, those factors including, preoperative serum creatinine (2.11 +/- 1.13 v 3.08 +/- 1.67 mg/dL) and preoperative 24-hour urine output (1358.6 +/- 745.9 v 755.2 +/- 572.1 mL/day) were significantly associated with requirement of dialysis. Using multivariate logistic regression, the significant risk factors independently associated with dialysis were preoperative serum creatinine (OR = 1.34) and preoperative 24-hour urine output (OR = 0.99). Patients with non- oliguric renal failure had significantly greater chance of recovering their renal function after cardiac surgery compared to those with oliguria (36.9% v 10.0%, P <.05). CONCLUSION: Preoperative 24-hour urine amount and pre-operative serum creatinine can provide valuable information for predicting the likelihood of developing acute renal failure and requiring dialysis in this subgroup of patients.  相似文献   

17.
医院获得性急性肾功能衰竭原因分析及预防对策   总被引:1,自引:0,他引:1  
目的分析医院获得性急性肾功能衰竭(HA-ARF)的各种易患因素,探讨其治疗及预防的特殊性,以提高HA-ARF的抢救成功率。方法回顾性分析在我院诊治及进行血液净化的HA-ARF 56例,其中进行血液透析30例,连续性静脉-静脉血液滤过(CVVH)5例,腹膜透析(CAPD)3例,内科保守治疗18例。结果所有患者均经积极治疗原发病、抗感染、输血、补液、利尿、控制血压等对症治疗,肾功能完全恢复32例(57%),部分恢复11例(20%),不能恢复需维持性血液透析5例(9%),死亡5例(9%),中途放弃治疗3例(5%)。结论HA-AHF病情变化快,早期积极治疗,根据病情需要选择不同的血液净化疗法可提高治疗成功率。  相似文献   

18.
S M Dirkes 《Nephrology nursing journal》2000,27(6):581-90; quiz 591-2
Acute renal failure (ARF) is a common complication of critically ill patients in today's intensive care units. Intermittent renal replacement therapy for these types of patients may be limited or ineffective due to the critical nature of their illness. Volume overload and hemodynamic instability are complications that may not be treated adequately with conventional forms of dialysis, such as hemodialysis or peritoneal dialysis. Continuous renal replacement therapy (CRRT) is rapidly gaining ground as the treatment of choice for ARF in the intensive care unit (ICU) due to its slow, gentle nature of water and solute removal Critical care nurses are responsible for monitoring this therapy, but a collaborative effort with nephrology nurses' expertise and background in dialysis therapies is a key ingredient in implementation of a successful CRRT program. This article will review the causes of ARF, the history of CRRT, current treatment options, trends, and implementation of a successful CRRT program.  相似文献   

19.
Sagy M  Silver P 《Critical care medicine》1999,27(11):2532-2536
OBJECTIVE: To describe a method of rapid fluid removal in children with anasarca and the acute respiratory distress syndrome (ARDS) secondary to sepsis or the systemic inflammatory response syndrome. DESIGN: Consecutive case series. SETTING: Pediatric Intensive Care Unit of a children's hospital. PATIENTS: Six patients with ARDS secondary to sepsis or systemic inflammatory response syndrome, who had persistent anasarca complicating their respiratory course despite intravenous diuretic therapy. INTERVENTIONS: Continuous flow peritoneal dialysis (CFPD) was instituted after percutaneously inserting two Tenckhoff dialysis catheters into the peritoneal cavity of each patient and tunneling them through the subcutaneous tissue to exit from opposite lower abdominal quadrants. A dialysis solution with 2.5% dextrose was administered continuously via one of the catheters at a rate ranging from 10-30 mL/kg/hr, and concomitantly drained via the other catheter. The concentration of the dialysis solution and rate of inflow were adjusted as needed to achieve the desired peritoneal outflow rate. CFPD was discontinued when adequate weight loss had occurred and the patient's daily urine output exceeded their daily fluid intake. The patient's overall fluid balance and change in weight were recorded daily. The PaO2/FiO2 ratio, alveolar-arterial oxygen gradient, and oxygenation index were also calculated daily. MEASUREMENTS AND MAIN RESULTS: Six patients with ARDS, mean age 18.7+/-37.0 months were mechanically ventilated for 8.0+/-4.0 days before CFPD, during which time average body weight increased to 63%+/-22% above admission body weight, despite the use of intravenous diuretic therapy. They underwent CFPD for 126.7+/-60.0 hrs, during which time their body weight decreased to 30%+/-12% above admission weight (p<.05). During dialysis, the dialysis outflow rate exceeded the inflow rate by 4.2+/-0.9 mL/kg/hr. When compared with values calculated immediately before starting CFPD, post-CFPD PaO2/FiO2 increased from 97.0+/-32.0 to 215.0+/-40.4 mm Hg (12.9+/-4.3 to 28.7+/-5.4 kPa) (p<.05), post-CFPD alveolar-arterial oxygen gradient decreased from 390.7+/-85.8 to 206.7+/-72.8 mm Hg (52.1+/-11.4 to 27.6+/-9.7 kPa) (p<.05), and post-CFPD the oxygenation index decreased from 29.6+/-9.8 to 11.8+/-5.6 (p<.05). There were no complications associated with dialysis catheter insertion or CFPD therapy. Four patients survived. Two patients had an irreversible course of infections and septic shock and died. CONCLUSION: Severe anasarca in the course of ARDS can be effectively treated in pediatric patients with continuous flow peritoneal dialysis, resulting in a significant improvement in respiratory status.  相似文献   

20.
【目的】探讨亚临床甲状腺功能减退(SCH)对持续不卧床腹膜透析(CAPD)患者容量负荷及贫血的影响。并观察左旋甲状腺素(LT)的干预作用。【方法】检测30例CAPD合并SCH患者及60例甲状腺功能正常的CAPD患者(B组)的超敏促甲状腺素(TSH),游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)及血红蛋白(Hb),细胞外液(ECW),体液总量(TBW),细胞外液与总体液总量之比(E/T)。将A组中的15例患者进行LT治疗(A1组)4周,观察Hb,容量负荷变化情况,并与未治疗的亚甲减组(A2组)进行比较。【结果】A组容量负荷高于,而Hb则低于B组。且差异有显著性(P〈0.01)。经予LT治疗4周后,A1组ECW减少,Hb上升,与治疗前比较差畀均有显著性(P〈0.01),较未治疗的A2组差异均有显著性(P〈0.05),且接近同时期单纯CAPD组患者水平。【结论]SCH可以加重CAPD患者容量负荷及贫血水平。LT干预治疗可以减轻该类患者的容量负荷并改善其贫血状况。  相似文献   

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