急性肾梗死的诊断和治疗

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1、万方数据急性肾梗死的诊断和治疗杨震宇李军吕福华付强瞿庆华王大伟夏圻儿盛畅谢平张旭龚溪明叶贤德·593··临床研究·【摘要】目的探讨急性肾梗死的晒床诊断和治疗方法。方法总结2例3次急性肾梗死患者的临床资料。例I，男，62岁，临床表现为突发左侧腰部疼痛，增强CT检查示左肾中上部低密度灶，增强扫描后无强化，诊断左肾局灶性梗死。行低分子肝素抗凝治疗。例2．女，54岁，第1次l临床表现为右侧腰腹疼痛，增强CT检查示右肾动脉主于栓塞。右肾完全梗死，行数字减影血管造影(DSA)检查以及导管内溶栓抗凝治疗，4个月后出现左侧腰痛。CT检查示左肾中部低辔度灶，增强后无强化，再次行DSA检查以

2、及导管内溶栓抗凝治疗。结果例1局灶性肾梗死治疗后2d增强MRI显示梗死灶大小同治疗前增强CT相似，复查肾功能正常，随访36个月无异常。例2第1次右肾完全梗死治疗后右肾血流均基本恢复，复查肾功能正常，随访4个月发生左肾局灶梗死，右肾轻度萎缩。再次治疗后左肾梗死灶血流基饩恢复．复查肾功能正常，继续随访lo个月，未再发脏器梗死。结论急性肾梗死的诊断可依靠增强CT检查，MRl亦能提供诊断。溶栓抗凝治疗效果主要取决于梗死的肾动脉段位置和早期发现。急诊时对于原因不明的突发持续腰、腹痛须警惕急性肾梗死。【关键词】急性肾梗死；诊断；治疗Thediagnosisandtreatmentof

3、acuterenalinfarctionFANGZhen—yu。，LIJun。LOFu一^lm。x髓qi-el-，SHENGChang。XIEPing，ZHANGXu，，￡，Qk，Ig，QUQing—hua。WANGDa-wei。GONGXi-ruing，YEXian-de．‘DepartmentofUrology，People’sHospitalofPudongNewArea，Shanghai201299，ChinaCorrespondingauthor：FANGZhen·yu，Emad：zhenyuyang@live．cn【Abstract】ObjectiveToev

4、aluatetheclinicaldiagnosisandtreatmentofacuterenalinfarction．MethodsTwocases(3sides)ofacuterenalinfarctionwerereported．Thepatientswerelmaleand1fe．male，withtheageof62and54years．Case1presentedacuteleftflankpain。andenhancedCTshowed8non-enhancedareaintheupperandmidpoleoftheleftkidney．Thediagn

5、osisoffocalrenalinfarctionWaSmadeandtreatedwithlow·molecularheparin(6000U)．Case2presentedacutebothrightabdominalandflankpain。andenhancedCTshowedrightrenalarteryembolismandrightrenalcompleteinfarction．Digitalsubtractionangiography(DSA)andcatheterthrombolytictherapywasapplied．4monthslater，t

6、hepatientpresentedacuteleftflankpain，andenhancedCTshowedalowdensityareainleftkidneywithoutenhancedbyContrast。andDSAandcatheterthrombolytictherapyWagappliedagain．ResultsincaseI，contrast-enhancedMRIshowedastillJOWsignslarealikeenhancedCTafter2daysoftreatment．Therenalfunotionremainednormalin

7、thefollow-upof36months．Incase2。thefightkidneyresortedtomoderatebloodflowbutbecameatrophylater．Inthefollow·upof4months，arecurrentfocalinfarctionWasconfirmedinleftkid—neybyenhancedCT．TheleftkidneyalsoresortedtomoderatebloodflowafterDSAandcatheterthrombolyt·ictherapy．T