摘要
目的:探讨影响重度闭合性肾损伤治疗决策的因素,最大限度保存肾功能并降低死亡风险。方法:回顾性分析76例重度闭合性肾损伤患者的临床资料,采用χ2检验、t检验及多因素Logistic回归分析方法分析各临床因素对治疗决策的影响。结果:76例重度闭合性肾损伤患者中,Ⅳ级53例,Ⅴ级23例。与非手术组比较,手术组收缩压(P=0.001)、舒张压(P=0.003)、血红蛋白水平(P=0.039)更低,心率更快(P=0.016),输血率更高(P<0.001),Ⅴ级肾损伤所占比例更高(P<0.001),肾周出血弥漫更明显(P=0.019)。在多因素Logistic回归分析中,肾损伤分级(OR=20.289,P=0.009)和心率(OR=1.08,P=0.027)是手术治疗的独立危险因素。非手术组中,微创治疗组患者血红蛋白更低(P<0.001),输血率更高(P=0.001),肾周血肿(PRD)更大(P=0.026)。受试者工作特征曲线(ROC)显示需要微创治疗的肾周血肿的最佳临界距离为3.1cm。在多因素回归分析中,PRD≥3.1cm(OR=73.547,P=0.002)是微创干预的唯一预测因素。结论:非手术治疗可用于重度闭合性肾损伤患者,其中PRD是介入干预治疗的重要指标,而肾损伤分级和心率的变化是手术探查的独立危险因素。
Objective： To explore the predictors affecting treatment decision-making of severe blunt renal inju- ries in order to protect renal function furthest and reduce the risk of death. Method： A retrospective study was performed in 76 severe renal trauma patients＇ clinical data. Chi-square test, t text, and multiple logistic regression were performed to analyze the impact of management decisions about different clinical factors. Result： Among 76 severe blunt renal injury patients, 53 patients were grade IV and 23 grade V. Compared with nonoperative groups, lower systolic blood pressure （P=0. 001）, lower diastolic blood pressure （P=0. 003）, lower hemoglobin （P=0.039）, increased heart rate （P=0.016）, more transfusions （P〈0.001）, more V grade injuries （P〈0. 001）, more diffuse bleeding （P=0. 019） were found in patients treated surgically. On multiple logistic regres- sion, injury grade （OR=20. 289, P=0. 009） and heart rate （OR=1. 08, P=0. 027） were the independent predic- tors of surgical treatment. In nonoperative group, low hemoglobin （P〈0. 001 ）, more transfusion （P = 0. 001 ） and larger perirenal hematoma size （P= 0. 026） were more frequent in patients for intervention. The cutoff perirenal hematoma rim distance （PRD） predicting intervention was 3.1 cm provided by receiver operating characteristic curve （ROC）. On multiple logistic regression, PRD greater than 3.1 cm （OR=73. 547, P=0. 002） was the only independent predictor of interventional treatment. Conclusion： Nonoperative approaches can be performed in patients in severe renal trauma. PRD is a significant predictor determining interventional treatment. Injury grade and heart rate were the independent factors of surgical treatment.
作者
王宁
郑小平
邓敏华
赵雄剑
万波
曾青
何乐业
WANG Ning;ZHENG Xiaoping;DENG Minhua;ZHAO Xiongjian;WAN Bo;ZENG Qing;HE Leye .(Department of Urology, Third Xiangya Hospital of Central South University, Changsha, 410013, China)
出处
《临床泌尿外科杂志》
2018年第3期189-192,共4页
Journal of Clinical Urology
关键词
闭合性肾损伤
治疗决策
影响因素
blunt renal injury
treatment decision-making
influencing factors
