经皮肾镜碎石术后大出血原因分析及防治措施.doc

精品论文 参考文献 经皮肾镜碎石术后大出血原因分析及防治措施 孙菊元 林思进 殷波 刘刚 　　(四川省攀枝花市第二人民医院 617065) 　　【摘要】 探究经皮肾镜碎石术术后大出血的原因及防治措施。方法 选取2008年1月～2013年1月到我院泌尿外科进行经皮肾镜碎石术术后大出血的35例患者作为研究对象，分析造成病人出现术后大出血的原因，并对原因进行统计学分析，找出可能引起大出血发生率增大的因素，对出血的预防与控制提供临床参考，并对出血病人进行介入栓塞止血的临床效果进行分析及讨论。结果 35例患者术后出血量800～2700ml，平均出血量(1200plusmn;680)ml。所有患者在出血后，均先以扩容、输血、局部压迫止血、药物止血、闭管等保守治疗进行止血，其中16(45.7%)例患者出血情况得到控制，19(54.3%)例患者经紧急介入栓塞治疗后，18例痊愈，其中1例因出血量过多而转行肾脏切除术。结论 手术前的充分准备，提高手术的熟练度，减少手术时间，及时有效的治疗是防治术后大出血的重要保障；对于出现大出血的患者进行及时的介入栓塞止血，可降低肾功能受损的机率，是经皮肾镜碎石术术后大出血的首选治疗方法。 　　【关键词】经皮肾镜碎石术 肾结石 大出血 　　【中图分类号】R619 【文献标识码】A 【文章编号】2095-1752（2014）17-0140-02 　　The Causes and Treatment of 35 Patients with Massive Hemorrhage after Percutaneous Nephrolithotomy 　　【Abstract】Objective This study explores the causes and treatment of massive hemorrhage after percutaneous nephrolithotomy. Methods This study chooses 35 patients as the object who are with massive hemorrhage after percutaneous nephrolithotomy and were treated in our hospitalrsquo;s urinary surgery from January 2008 to January 2013. The study analyzes the causes of patientsrsquo; massive hemorrhage after the surgery. It makes the statistical analysis on the causes and finds out the factors that may cause the increase of massive hemorrhage rate. It provides clinical reference for the prevention and control of massive hemorrhage. It also analyzes the clinical effect of interventional embolization for patients who are with massive hemorrhage.Results The blood loss of the 35 patients is from 800ml to 2700ml after operation. The average blood loss is (1200plusmn;680)ml. After the hemorrhage, all patients are performed expectant treatment to stop bleeding firstly, such as dilatation, blood transfusion, local oppression hemostasis, drug hemostasis, closed tube and so on. 16 patientsrsquo;(45.7%) hemorrhages are under control. 19 patients(54.3%) are performed emergency interventional embolization. Among them, 18 patients recov