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剖宫产后TTP致妊娠相关急性肾损伤一例经验与教训 预览

Experiences and Lessons of One Postpartum Thrombotic Thrombocytopenic Purpura with Hemorrhage Lead to Preg-nancy-related Acute Kidney Injury
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摘要 目的 探讨产后急性肾损伤(acute kidney injury,AKI)的病因和妥善处理措施,提高妊娠相关急性肾损伤(pregnancy related acute kidney injury,PR-AKI)的救治能力。方法 回顾分析1例二胎剖宫产术后5 d发生的PR-AKI的临床资料。结果 31岁产妇,因水肿1月余,剖宫产后5 d,少尿4 d入院。入院时合并严重感染、贫血、血小板减少,肝、肾功能损害,肌酶升高,凝血功能异常,诊断为继发性血栓性血小板减少性紫癜(thrombotic thrombocytopenic purpura,TTP)所致的AKI。查体发现右股静脉置管部位血肿,腹部超声示腹腔血肿,经双侧髂动脉造影发现右侧髂内动脉两个分支出血,行血管栓塞术。病程中相继出现鼻腔、痔出血,急性左心衰竭,予抗感染、血液滤过、糖皮质激素等综合治疗,2.5个月后痊愈出院。结论 TTP、产后出血均是PR-AKI的重要病因,二者共存导致病情复杂。PR-AKI患者在不能手术探查的情况下,应及时选择血管造影明确出血原因及部位,行选择性血管栓塞止血以免病情恶化,促进患者肾功能恢复。 Objective To investigate pathogenesis and the treatment measure of patients with acute kidney injury (AKI) after cesarean in order to improve rescuing ability of pregnancy-related acute kidney injury (PR-AKI). Methods Clinical data of one patient with PR-AKI at postoperative 5th d after cesarean section was retrospectively analyzed. Results A 31-year old woman was admitted for edema and oliguresis at postoperative 5th d after cesarean section, and she was diagnosed as having AKI caused by thrombotic thrombocytopenic purpura (TTP) , combined with infection, anemia, thrombocytopenia, liver and renal function damage, high phosphocreatinase, thrombin dysfunction. Physical examination discovered the hemato-ma in the right femoral vein and abdominal hematoma was confirmed by ultrasonic testing. She accepted embolotherapy when arteriography verified the bleeding of two branchs in the right internal iliac artery. In course of disease, she had nasal bleeding and haemorrhoids bleeding. She had accepted anti-infection, hemofiltration and glucocorticoid therapy, recoveried and dis-charged two and a half months later. Conclusion Both the TTP and postpartum hemorrhage are importance pathogenesis of PR-AKI, the patient's condition worsened when they coexistd. If inoperable, angiograph testing can clear and definite the bleeding reason and position, reduce the misdiagnosis, electivity transarterial embolization can prevent the illness and recovery renal function.[
作者 杨新军 林静 汪晶华 刘宇 陈云爽 吴广礼 YANG Xin-jun, LIN Jing, WANG Jing-hua, LIU Yu, CHEN Yun-shuang, WU Guang-li (Department of Nephrology, Be- thune International Peace Hospital of PLA, Shijiazhuang 050082, China)
出处 《临床误诊误治》 2018年第1期34-37,共4页 Clinical Misdiagnosis & Mistherapy
关键词 剖宫产术 手术后并发症 产后出血 急性肾损伤 紫癜 血栓性血小板减少性 Cesarean Complication Postpartum hemorrhage Acute kidney injury Purpura, thrombotic thrombocy-topenic purpura
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