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目的:讨论肾梗死和胡桃夹子综合征临床症状及治疗方法。方法:回顾性分析3例急性肾梗死和1例胡桃夹子综合征患者的临床特点及诊疗方法:除1例患者无高血压、发热外,3例发热,血压和乳酸脱氢酶(LDH)增高。4例均有血尿、腰痛、恶心,血常规增高。2例行CT检查,其中1例行肾脏MRI检查证实为左肾栓塞梗死,右肾挫裂伤肝破裂,行左肾切除、右肾部分切除肝修补术;1例溶栓治疗。1例由于梗塞时间过长,失去溶栓治疗机会,给予控制血压、血糖并给予低分子肝素(每天10~250U)和肠溶阿司匹林(每天0.3g)治疗。1例行MRA证实为胡桃夹子综合征,行自体肾移植。结果:1例溶栓治疗者恢复部分肾功能;1例行左肾切除、右肾部分切除及肝修补术者肾功能处于临界值,痊愈出院;1例行自体肾移植者痊愈出院;1例给予低分子肝素和肠溶阿司匹林治疗者体温恢复正常,腰腹部疼痛缓解。结论:急性肾梗死和胡桃夹子综合征的临床症状和CT表现容易混淆。对急性肾梗死,早期溶栓治疗能恢复部分肾功能。对左肾梗死要考虑到胡桃夹子综合征的可能。
Objective: To discuss the clinical symptoms and treatment of renal infarction and nutcracker syndrome. Methods: The clinical features, diagnosis and treatment of 3 patients with acute renal failure and 1 nutcracker syndrome were retrospectively analyzed. Except for 1 patient without hypertension and fever, 3 patients had fever, blood pressure and lactate dehydrogenase (LDH) increased . 4 cases were hematuria, back pain, nausea, blood increased. 2 routine CT examination, of which 1 case of renal MRI examination confirmed the left renal embolism, right renal contusion and rupture of the liver rupture, left renal resection, partial renal resection of the right kidney; 1 case of thrombolytic therapy. One patient suffered from thrombolysis due to the prolonged infarct time. He was given blood pressure control and blood glucose control and was given low molecular weight heparin (10 ~ 250 U / day) and enteric-coated aspirin (0.3 g / day). A routine MRA confirmed Nutcracker syndrome, autologous kidney transplantation. Results: One patient with thrombolysis recovered partial renal function. One patient underwent left nephrectomy, partial nephrectomy and hepatic repair were at a critical level and were discharged. One patient underwent autologous kidney transplant and recovered. One patient Given low molecular weight heparin and enteric-coated aspirin body temperature returned to normal, waist and abdominal pain relief. Conclusions: The clinical symptoms and CT findings of acute renal failure and nutcracker syndrome are easily confused. For acute renal infarction, early thrombolytic therapy can restore some renal function. The left renal infarction to consider the possibility of Nutcracker syndrome.