CAJ | 학술논문

目的探讨小儿泌尿系结石并急性肾功能衰竭的药物应用情况,以及合理的治疗方案.方法收集分析2008年7月至2012年6月收治的41例急性肾功能衰竭的患儿资料,泌尿系超声均提示双肾实质弥漫性回声增强,肾盏、肾盂及输尿管内可见明确泥沙样强回声沉积物,X线检查均未见结石显影.发病前均有头孢曲松钠等药物应用病史.所有患儿入院后均给予解痉及碱化尿液治疗,17例患儿联合应用血液透析治疗,4例行输尿管镜下输尿管置管.结果 24例患儿经单纯解痉、碱化尿液治疗后24 h内恢复排尿,11例给予血液透析1次恢复排尿,2例经血液透析2次后恢复排尿,4例行输尿管镜下输尿管置管术后恢复排尿.1周后复查彩色多普勒超声,39例结石完全消失,肾实质回声恢复正常.2例残留结石直径小于5 mm,无自觉不适症状,出院后给予枸橼酸氢钾钠颗粒口服,1个月后复查结石消失.结论药物应用不当可能导致小儿泌尿系结石并急性肾功能衰竭,及时停药并给予解痉、碱化尿液治疗,必要时辅以血液透析或输尿管置管可以有效逆转肾功能损害,结石多在尿量正常后排出.
목적 탐토소인비뇨계결석병급성신공능쇠갈적약물응용정황,이급합리적치료방안.방법 수집분석2008년7월지2012년6월수치적41례급성신공능쇠갈적환인자료,비뇨계초성균제시쌍신실질미만성회성증강,신잔、신우급수뇨관내가견명학니사양강회성침적물,X선검사균미견결석현영.발병전균유두포곡송납등약물응용병사.소유환인입원후균급여해경급감화뇨액치료,17례환인연합응용혈액투석치료,4례행수뇨관경하수뇨관치관.결과 24례환인경단순해경、감화뇨액치료후24 h내회복배뇨,11례급여혈액투석1차회복배뇨,2례경혈액투석2차후회복배뇨,4례행수뇨관경하수뇨관치관술후회복배뇨.1주후복사채색다보륵초성,39례결석완전소실,신실질회성회복정상.2례잔류결석직경소우5 mm,무자각불괄증상,출원후급여구연산경갑납과립구복,1개월후복사결석소실.결론 약물응용불당가능도치소인비뇨계결석병급성신공능쇠갈,급시정약병급여해경、감화뇨액치료,필요시보이혈액투석혹수뇨관치관가이유효역전신공능손해,결석다재뇨량정상후배출.
Objective To analyze the treatment of acute renal failure caused by irrational drug use.Method Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed.Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases.Calculus image was not found by X-ray.All children had medical history of using cephalosporins or others.Alkalinization of urine and antispasmodic treatment were given to all children immediately,17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement.Result In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours,in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice,4 children who accepted intraureteral cannula immediately restored micturition.In all children micturition recovered gradually after a week of treatment.Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal.The residual calculi with diameter less than 5 mm were found in 2 children,but they had no symptoms.The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital.Ultrasound showed calculus disappeared totally one month later.Conclusion Irrational drug use can cause children urolithiasis combined with acute renal failure,while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine,antispasmodic treatment,intraureteral cannula or hemodialysis when necessary,most calculus can be expelled after micturition recovered to normal.