梗阻性急性肾功能衰竭118例病因分析及急诊处理

目的探讨梗阻性急性肾功能衰竭(ARF)患者的病因及急诊处理方法。方法回顾性分析118例梗阻性ARF患者的病因,并评价其急诊处理方法(包括输尿管插管术、皮肾穿刺造瘘术、肾造瘘术、输尿管切开术等)的效果。结果 118例梗阻性ARF患者中,因泌尿系统结石导致梗阻者73例(61.9%),肿瘤局部浸润或压迫输尿管16例(13.6%),其他原因引起的梗阻包括泌尿系结核9例(7.6%)、前列腺增生6例(5.1%)。经急诊治疗,成功解除梗阻89例,总有效率达75.4%,1周内死亡6例。109例均行输尿管插管术,其中成功引流并解除梗阻65例,这部分患者梗阻解除后肾功能迅速好转。24例患者行经皮肾穿刺造瘘术,均成功解除梗阻,血尿素氮、血肌酐1周内明显下降。结论梗阻性ARF的主要病因是泌尿系结石,其次为恶性肿瘤、结核及前列腺增生;急诊解除梗阻是治疗的关键,输尿管插管引流术是首选方法。

Analysis of causes and emergency treatments of 118 cases of obstructive acute renal failure

Objective To discuss etiological factor and emergency treatment of obstructive acute renal failure(ARF).Methods Retrospective study was employed to analyze the etiological factors of 118 cases of obstructive ARF and evaluate the effects of emergency treatment including ureteral catheterization,percutaneous nephrostomy,nephrostomy,ureterotomy,etc.Results Among 118 cases of obstructive ARF,there were 73 cases(61.9%)of obstructive ARF due to urinary tract obstruction,16 cases(13.6%) due to local tumor invasion or ureter oppression and others including 9 cases(7.6%) of urinary tuberculosis,6 cases(5.1%) of prostatic hyperplasia.After emergency treatment,successful relief of obstruction was found in 89 cases and the total effective rate was 75.4%,with 6 deaths within a week.Ureteral catheterization operation were performed in 109 patients.Successful drainage and relief of obstruction was found in 65 patients whose postoperative renal function improved rapidly.24 patients accepted percutaneous nephrostomy and the obstruction was all successfully removed,with blood urea nitrogen and serum creatinine of them decreased significantly in a week.Conclusion The main etiological factor of obstructive ARF is urolithiasis,followed by malignant tumor,tuberculosis and prostatic hyperplasia.Emergency relief of obstruction is the key to the treatment,and the ureteral catheterization drainage is the preferred method.