CAJ | 학술논문

目的探讨急性肾梗死的临床诊断和治疗方法. 方法总结2例3次急性肾梗死患者的临床资料.例1,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次临床表现为右侧腰腹疼痛,增强CT检查示右肾动脉主干栓塞,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检查示左肾中部低密度灶,增强后无强化,再次行DSA检查以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本恢复,复查肾功能正常,继续随访10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,MRI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.
목적 탐토급성신경사적림상진단화치료방법. 방법 총결2례3차급성신경사환자적림상자료.례1,남,62세,림상표현위돌발좌측요부동통,증강CT검사시좌신중상부저밀도조,증강소묘후무강화,진단좌신국조성경사,행저분자간소항응치료.례2,녀,54세,제1차림상표현위우측요복동통,증강CT검사시우신동맥주간전새,우신완전경사,행수자감영혈관조영(DSA)검사이급도관내용전항응치료,4개월후출현좌측요통,CT검사시좌신중부저밀도조,증강후무강화,재차행DSA검사이급도관내용전항응치료. 결과 례1국조성신경사치료후2d증강MRI현시경사조대소동치료전증강CT상사,복사신공능정상,수방36개월무이상.례2제1차우신완전경사치료후우신혈류균기본회복,복사신공능정상,수방4개월발생좌신국조경사,우신경도위축.재차치료후좌신경사조혈류기본회복,복사신공능정상,계속수방10개월,미재발장기경사. 결론 급성신경사적진단가의고증강CT검사,MRI역능제공진단.용전항응치료효과주요취결우경사적신동맥단위치화조기발현.급진시대우원인불명적돌발지속요、복통수경척급성신경사.
Objective To evaluate the clinical diagnosis and treatment of acute renal infarction.Methods Two cases (3 sides) of acute renal infarction were reported.The patients were 1 male and 1 female,with the age of 62 and 54 years.Case 1 presented acute left flank pain,and enhanced CT showed a non-enhanced area in the upper and mid pole of the left kidney.The diagnosis of focal renal infarction was made and treated with low-molecular heparin (6000 U ).Case 2 presented acute both right abdominal and flank pain,and enhanced CT showed right renal artery embolism and right renal complete infarction.Digital subtraction angiography (DSA) and catheter thrombolytic therapy was applied.4 months later,the patient presented acute left flank pain,and enhanced CT showed a low density area in left kidney without enhanced by contrast,and DSA and catheter thrombolytic therapy was applied again.Results In case 1,contrastenhanced MRI showed a still low signal area like enhanced CT after 2 days of treatment.The renal function remained normal in the follow-up of 36 months.In case 2,the right kidney resorted to moderate blood flow but became atrophy later.In the follow-up of 4 months,a recurrent focal infarction was confirmed in left kidney by enhanced CT.The left kidney also resorted to moderate bloodflow after DSA and catheter thrombolytic therapy.The renal function became normal after follow-up of 10 months and no new infarction was observed.Conclusions The diagnosis of acute renal infraction could be made by enhanced CT or MRI.Early diagnosis and location of the infraction renal artery is critical for recovery of the impaired renal function.Acute renal infraction should be suspected in patients with unexplained persistent and steady flank or abdominal pain in emergence department.