B型主动脉夹层对肾脏血流和功能的影响

摘要

目的 探讨B型主动脉夹层患者双侧肾动脉受累情况及术前的肾功能指标变化.方法 回顾性分析2011年11月至2013年6月连续诊治的110例B型主动脉夹层患者的220支肾动脉发生不同缺血类型受累数目及术前肌酐、尿素、尿酸指标,并结合CTA、DSA检查进行分析.结果 110例患者(男92例,女18例)共220支肾动脉中,完全起自真腔的共167支(75.9％),完全起自假腔的共45支(20.5％),内膜片撕入、肾动脉内可见真假腔形成的共4支(1.8％).动力型缺血共42支(19.1％),静力型缺血(包括1～3型)共79支(35.9％).双侧肾动脉均未受累的男、女患者术前尿素分别为(6.2±1.2) mmol/L、(6.2±1.5) mmol/L,肌酐(80.40±15.01).μmol/L、(64.60±11.72) μmol/L,尿酸(311.96±65.94)μmol/L、(245.10±64.76) μmol/L;单侧肾动脉受累的男、女患者术前尿素分别为(8.60±3.55) mmol/L、(5.70±1.13) mmol/L,肌酐(108.70±46.29) μmol/L、(57.90±5.88) μmol/L,尿酸(340.70±82.45).μmoL/L、(256.10±52.36) μmol/L;双侧肾动脉均受累的男、女患者术前尿素(8.70±3.12)mmol/L、(7.10±2.47) mmol/L,肌酐(111.70±46.44) μmol/L、(70.30±11.78) μmol/L,尿酸分别为(342.30±73.78) iμmol/L、(301.90±70.56) μmol/L.结论 B型主动脉夹层易累及肾动脉,本组以右肾动脉为著.随着受累肾动脉数目的增加,患者肾功能指标呈进行性上升趋势,男性单支或双支肾动脉受累患者肾功能指标均已超出正常上限.应增加对B型主动脉夹层患者受累肾动脉及肾功能的关注.%Objective To discuss B type aortic dissection affect renal function and blood volume.Methods A retrospective analysis of the center continuous hospitalized 110 cases B type aortic dissection,observe the condition of renal artery be involved and carbamide 、creatinine、lithic acid level preoperative.Results 220 renal arteries in 110 cases(male 92 cases,female 18 cases),167 (75.9％) renal arteries origin from true lumen,45 (20.5％) renal arteries origin from false lumen,in 4 (1.8％) renal arteries can find intimal flap,42(19.1％) renal arteries are dynamic ischemia; and 79(35.9％) renal arteries are static ischemia.In preoperative,for male and female patient with bilateral renal artery are normal,carbamide are (6.2 ± 1.2) mmol/L and (6.2 ± 1.5) mmol/L,creatinine are (80.40 ± 15.01) μmol/L and (64.60 ± 11.72) μmol/L,lithic acid are (311.96 ± 65.94)μmol/L and (245.10 ± 64.76) μmol/L.For male and female patient with single renal artery be involved,carbamide are (8.60 ±3.55) mmol/L and (5.70 ± 1.13) mmol/L,creatinine are (108.70 ±46.29) pmol/L and (57.90 ± 5.88) μ mol/L,lithic acid are (340.70 ± 82.45) μmol/l,(256.10 ± 52.36) pmol/L.For male and female patient with bilateral renal artey be involved,carbamide are (8.70 ± 3.12) mmol/L and (7.10 ± 2.47) mmol/L,creatinine are (111.70 ±46.44) μmol/L and (70.30 ± 11.78) μmol/L,lithic acid was (342.30 ±73.78) μmol/L and(301.90 ± 70.56) μmol/L.Conclusion For B type aortic dissection,renal artey is easy to be involved,right side is more common in this group.Corresponding with increasing of renal artery,renal function become worse.For male patient,no matter single or bilateral renal artey be involved,renal function level is beyond normal.We should pay more attention to renal artery with type B aortic dissection.