超声引导下经皮肾穿刺活检术后出现肾包膜下血肿的危险因素分析
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摘要
目的分析超声引导下经皮肾穿刺活检术后出现肾包膜下血肿的危险因素。方法收集2015年11月~2017年11月本院收治的行超声引导下经皮肾穿刺活检术后出现肾包膜下血肿的患者135例作为试验组,以及同期行超声引导下经皮肾穿刺活检术后未出现肾包膜下血肿的患者133例作为对照组,分析两组的临床资料,并对其术后出现肾包膜下血肿的危险因素进行深入的探讨。结果促凝药物的使用与否、穿刺次数、穿刺长度、血尿酸、凝血酶原时间、血肌酐、血白蛋白、血小板、血红蛋白、起病时间是超声引导下经皮肾穿刺活检术后肾包膜下血肿出现的相关危险因素,其中血肌酐是高危因素,P<0.05,具统计学差异。结论对于超声引导下经皮肾穿刺活检术的患者,围术期应加强对血肌酐的监测,同时临床医师应提高自身穿刺技术,最大限度的降低肾包膜下血肿发生率。
Objective Toanalyzetheriskfactorsofsubcapsularhematomaafterpercutaneousrenalbiopsyunderultrasoundguidance.Methods From November 2015 to November 2017, 135 patients with subcapsular hematoma after percutaneous nephrolithotomy under ultrasound-guided ultrasound were enrolled in the hospital as the experimental group and ultrasound-guided percutaneous nephrolithotomy. 133 patients with no subcapsular hematoma after biopsy were used as the control group. The clinical data of the two groups were analyzed and the risk factors of subcapsular hematoma were discussed. Results The use of procoagulant drugs, number of punctures, puncture length, blood uric acid, prothrombin time, serum creatinine, serum albumin, platelet, hemoglobin, and onset time were ultrasound-guided percutaneous nephrostomy after renal biopsy. The risk factors related to the occurrence of submural hematoma, among which serum creatinine is a high-risk factor, P<0.05, with statistically significant differences.Conclusion For patients with ultrasound-guided percutaneous nephrolithotomy, perioperative serum creatinine should be monitored, and clinicians should improve their own puncture techniques to minimize the incidence of subcapsular hematoma.
Objective Toanalyzetheriskfactorsofsubcapsularhematomaafterpercutaneousrenalbiopsyunderultrasoundguidance.Methods From November 2015 to November 2017, 135 patients with subcapsular hematoma after percutaneous nephrolithotomy under ultrasound-guided ultrasound were enrolled in the hospital as the experimental group and ultrasound-guided percutaneous nephrolithotomy. 133 patients with no subcapsular hematoma after biopsy were used as the control group. The clinical data of the two groups were analyzed and the risk factors of subcapsular hematoma were discussed. Results The use of procoagulant drugs, number of punctures, puncture length, blood uric acid, prothrombin time, serum creatinine, serum albumin, platelet, hemoglobin, and onset time were ultrasound-guided percutaneous nephrostomy after renal biopsy. The risk factors related to the occurrence of submural hematoma, among which serum creatinine is a high-risk factor, P<0.05, with statistically significant differences.Conclusion For patients with ultrasound-guided percutaneous nephrolithotomy, perioperative serum creatinine should be monitored, and clinicians should improve their own puncture techniques to minimize the incidence of subcapsular hematoma.
引文
[1]杜刚.超声引导下经皮肾穿刺活检的临床应用[J].中国冶金工业医学杂志,2017,34(3):292-293.
[2]Sohns JM,Menke J,Staab W,et al.Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation[J].Fortschritte auf dem Gebiete der R ntgenstrahlen und der Nuklearmedizin,2014,186(9):860-867.
[3]李天,孙祥宙,李逊,等.输尿管软镜碎石术后并发肾周血肿的诊治[J].实用医学杂志,2017,33(5):756-758.
[4]程瑞洪,简讯,李斌,等.经皮肾穿刺活检的超声引导技巧研究(附846例分析)[J].四川医学,2014,35(3):290-292.
[5]李荣成,赵秀民,于经瀛.CT引导下经皮肺穿刺活检的临床应用(附82例报告)[J].当代医学,2011,17(5):53-54.
[6]林新广,时红娟,耿云,等.超声引导实时监控下经皮肾穿刺活检149例分析[J].中国中西医结合肾病杂志,2016,17(7):624-625.
[7]齐强元,徐英民,孟凡敏.经皮肾镜微创术后肾包膜下积液或血肿的治疗体会[J].中国继续医学教育,2017,9(16):147-149.
[8]桂志明,柳建军,苏劲,等.输尿管镜碎石术后继发肾包膜下血肿的相关风险因素[J].现代泌尿外科杂志,2017,22(5):357-360.
[9]林碧锋,林德水,张少贵.浅谈床旁超声引导在肾穿刺活检术中的应用效果[J].当代医药论丛,2015,13(24):62-63.
[10]吴岭,高珺,娄可新,等.超声引导下巴德穿刺枪在肾活检的临床应用分析[J].中华全科医学,2015,13(11):1794-1795.
[11]周海军,卢洪凯,王永传,等.后腹腔镜下肾包膜切除术和经皮穿刺引流术治疗特发性肾脏包膜下积液的临床分析[J].国际泌尿系统杂志,2016,36(1):79-83.
[12]张媛,朱达明.肾绞痛伴肾包膜下积液的超声诊断与临床价值分析[J].中国医学创新,2015,12(21):153-154.
[13]Nour-Eldin NEA,Alsubhi M,Naguib NN,et al.Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients[J].European Journal of Radiology,2014,83(10):1945-1952.
[14]沈海燕,李向东.解析实时超声引导下经皮肾脏穿刺活检技术的应用及临床诊断价值[J].当代医学,2013.19(14)102.
[15]张关华.超声引导经皮肾穿刺活检术238例分析[J].江苏医药,2015,41(17):2088-2089.
[2]Sohns JM,Menke J,Staab W,et al.Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation[J].Fortschritte auf dem Gebiete der R ntgenstrahlen und der Nuklearmedizin,2014,186(9):860-867.
[3]李天,孙祥宙,李逊,等.输尿管软镜碎石术后并发肾周血肿的诊治[J].实用医学杂志,2017,33(5):756-758.
[4]程瑞洪,简讯,李斌,等.经皮肾穿刺活检的超声引导技巧研究(附846例分析)[J].四川医学,2014,35(3):290-292.
[5]李荣成,赵秀民,于经瀛.CT引导下经皮肺穿刺活检的临床应用(附82例报告)[J].当代医学,2011,17(5):53-54.
[6]林新广,时红娟,耿云,等.超声引导实时监控下经皮肾穿刺活检149例分析[J].中国中西医结合肾病杂志,2016,17(7):624-625.
[7]齐强元,徐英民,孟凡敏.经皮肾镜微创术后肾包膜下积液或血肿的治疗体会[J].中国继续医学教育,2017,9(16):147-149.
[8]桂志明,柳建军,苏劲,等.输尿管镜碎石术后继发肾包膜下血肿的相关风险因素[J].现代泌尿外科杂志,2017,22(5):357-360.
[9]林碧锋,林德水,张少贵.浅谈床旁超声引导在肾穿刺活检术中的应用效果[J].当代医药论丛,2015,13(24):62-63.
[10]吴岭,高珺,娄可新,等.超声引导下巴德穿刺枪在肾活检的临床应用分析[J].中华全科医学,2015,13(11):1794-1795.
[11]周海军,卢洪凯,王永传,等.后腹腔镜下肾包膜切除术和经皮穿刺引流术治疗特发性肾脏包膜下积液的临床分析[J].国际泌尿系统杂志,2016,36(1):79-83.
[12]张媛,朱达明.肾绞痛伴肾包膜下积液的超声诊断与临床价值分析[J].中国医学创新,2015,12(21):153-154.
[13]Nour-Eldin NEA,Alsubhi M,Naguib NN,et al.Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients[J].European Journal of Radiology,2014,83(10):1945-1952.
[14]沈海燕,李向东.解析实时超声引导下经皮肾脏穿刺活检技术的应用及临床诊断价值[J].当代医学,2013.19(14)102.
[15]张关华.超声引导经皮肾穿刺活检术238例分析[J].江苏医药,2015,41(17):2088-2089.