经股动脉导管治疗急性肾梗塞的临床应用（附2例报告）

目的探讨介入方法—即经股动脉导管大剂量单次冲洗,及留置导管持续溶栓药物灌注,在急性肾梗塞病例中的临床疗效及应用价值。方法我院于2005年收治2例高度怀疑急性肾梗塞病人,为延缓肾脏功能损伤及最大程度降低患者检查费用,对该2例病人即刻行腹主动脉及双肾动脉造影,术中发现该2例患者均有明确单侧肾动脉主干及属支血栓形成,结合病史考虑以新鲜血栓为主,遂于术中行大剂量溶栓药物冲洗,以达到最短时间内最大程度消融血栓（尿激酶3000～5000IU/min,总量50万u,经导管注入靶血管内）,灌注完毕后经导管再次造影,可见血栓有明确消融迹象（详见本文所附DSA片）。证实药物溶栓有效后,留置导管于靶血管内,以肝素盐水封管、封鞘（1%肝素盐水各10mL）。嘱患者回病房后,每日以微量泵经留置导管向靶血管内持续注入尿激酶25万u,注入时间控制在8～10h内。每日灌注完毕后均以1%肝素盐水封管、封鞘（各10mL）。并定时监测凝血功能。结果该2例病人1周后再次经留置导管行靶血管造影,可见血栓消失,靶血管远端血运开通。即拔除留置导管、血管鞘,加压包扎右股动脉穿刺点。嘱患者右下肢制动24h卧床,并予预防性抗炎、水化治疗3～5d后。复查肾功正常,病人临床症状明显消失。治疗结束。结论经股动脉导管治疗急性肾梗塞疗效确切,经计费用低廉。不失为急性肾梗塞病例的首选治疗方案。

Clinical Application on Treatment of Acute Renal Infarction via Femoral Artery Catheter

Objective To discuss the curative effect and clinical application value of two interventional methods, single large dose irrigation and retention continuous perfusion in acute renal infarction (ARI). Methods 2 cases who were suspected as ARI were detected with abdominal aorta and renal artery angiography to delay the renal function injury and lower charges. The fresh thrombosis had formed in single renal artery and its involved branches according to history in two cases. Half million unit urokinase was irrigated to target blood vessel and the DSA had shown thrombolysis after treatment. The catheter remained in target vessel to pump the urokinase quarter million unit per day within 8～10 h. The heparin was injected to prevent obstruction of catheter. ACT was monitored. Results The angiography was made after 1 week and the results showed that thrombosis disappeared and distal vessel open. The catheter was pulled out and patient stayed in bed for 24 h, anti-infection for 3～5 d. The renal function and symptom of patient were normal. Conclusion This method might have good effect and low charges that should be first choice for such patient.