西藏地区肾穿刺活检术后出血风险分析

doi:10.19723/j.issn.1671-167X.2021.02.011

摘要/Abstract

摘要：

目的: 观察我国西藏地区肾穿刺活检术(percutaneous renal biopsy,PRB)术后出血情况,分析总结与高原地区患者出血相关的危险因素,提高手术安全性。方法: 选择西藏自治区人民医院肾脏内科2016年5月至2018年5月收治的经皮肾穿刺活检术患者临床资料进行回顾性研究,分析诸因素(性别、年龄、血压、血红蛋白、血小板、血肌酐、凝血酶原时间和活化部分凝血酶原时间)与术后出血事件的相关性。结果: 共收集病例150例,平均年龄(41.2±15.6)岁,其中男性比例为58.7%(88/150),女性为41.3%(62/150),术后出血12例(男、女各6例),出血比例8.0%(12/150)。出血组平均年龄与无出血组相比,有偏高趋势[(48.3±20.0)岁vs. (40.6±15.1)岁,P=0.099]。出血组较无出血组高血压发生率、血红蛋白增多症发生率、尿素氮、凝血酶原时间差异均无统计学意义(P>0.05)。出血组血肌酐水平有高于无出血组趋势(P=0.090),出血组较无出血组活化部分凝血酶原时间有延长趋势(P=0.069)。出血组血小板计数明显低于无出血组(P<0.05)。多因素Logistic回归分析发现,活化部分凝血酶原时间延长和较低的血小板计数具有相对较高的出血风险,差异有统计学意义(P=0.079,P=0.082)。结论: 高原地区行PRB总体上是安全、可靠的;高龄、低血小板、肾功能下降、活化部分凝血酶原时间延长与PRB术后出血相关,高血红蛋白不是高原地区PRB术后出血的危险因素。

关键词: 西藏地区, 经皮肾穿刺活检术, 出血

Abstract:

Objective: To observe the postoperative bleeding after percutaneous renal biopsy (PRB) in Tibet, To analyze and summarize the risk factors associated with bleeding in high altitude patients to improve the safety of surgery. Methods: A retrospective analysis of 150 cases of PRB in the Department of Nephrology, People’s Hospital of Tibet Autonomous Region from May 2016 to May 2018 were carried out, and the correlations between the potential risk factors (gender, age, blood pressure, hemoglobin, platelet, serum creatinine) and postoperative bleeding events were analyzed. Results: During the study period, the 150 patients receiving procedure of PRB were enrolled in our hospital, with an average age of (41.2±15.6) years, of whom 58.7% (88/150) were male, 41.3% (62/150) were female, and major bleeding complications occurred in 12 biopsies (8.0%, 12/150). Six cases for men and women, respectively. The mean age in the bleeding group seemed to be higher than that in the non-bleeding group [(48.3±20.0) years vs. (40.6±15.1) years, P=0.099]. There was no significant difference in the incidence of hypertension, hemoglobinemia, urea nitrogen and prothrombin time between the two groups. The level of serum creatinine in the hemorrhage group seemed to be higher than that in the non-bleeding group (P=0.090), and the time of the hemorrhagic group was longer than that in the non-bleeding group (P=0.069). The platelet count in the bleeding group was significantly lower than that in the non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that the prolonged activation of partial prothrombin time and lower platelet count had a relatively high risk of bleeding, which was statistically significant (P=0.079, P=0.082). Conclusion: PRB is safe and reliable on the whole in plateau areas; Old age, low platelet count, decreased renal function and prolonged activated partial coagulation time are related to postoperative bleeding of PRB, and hyperhemoglobin is not a risk factor for bleeding. High hemoglobin is not a risk factor for postoperative bleeding of PRB at high altitude.

Key words: Tibet area, Percutaneous renal biopsy, Bleeding complication

中图分类号:

R605

张蕾,李国梁,党宗辉,次仁罗布,阿勇,吴玲洁,刘立军. 西藏地区肾穿刺活检术后出血风险分析[J]. 北京大学学报（医学版）, 2021, 53(2): 298-301.

ZHANG Lei,LI Guo-liang,DANG Zong-hui, ,A yong,WU Ling-jie,LIU Li-jun. Analysis of bleeding risk in percutaneous renal biopsy in Tibet[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 298-301.

图/表 2

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参考文献 19

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Items	Bleeding group (n=12)	Non bleeding group (n=138)	P
Gender, male/female	6/12	82/138	0.525
Age/years	48.3±20.0	40.6±15.1	0.099
Dystolic pressure/mmHg	141.4±29.3	132.1±23.8	0.202
Diastolic pressure/mmHg	93.9±19.8	93.2±75.0	0.974
Hypertension, n (%)	8 (66.7)	71 (51.4)	0.311
Hemoglobin/(g/L)	139.6±39.5	141.4±34.0	0.865
HAPC, n (%)	0 (0.0)	4 (2.7)	0.550
Scr/(μmol/L)	175.8±154.4	119.1±106.2	0.090
BUN/(mmol/L)	11.1±10.6	9.1±10.6	0.519
PT/s	13.1±1.5	13.1±3.9	0.940
APTT/s	43.9±7.1	40.1±7.0	0.069
Platelet/(×10⁹/L)	178.5±78.5	226.8±79.3	0.045

Items	Multivariate Logistic analysis
Items	OR (95%CI)	P
Age	1.02 (0.97-1.07)	0.456
Dystolic pressure	1.00 (0.98-1.03)	0.769
Diastolic pressure	1.00 (0.99-1.01)	0.939
Hemoglobin	1.00 (0.98-1.02)	0.749
Scr	1.00 (1.00-1.01)	0.340
BUN	1.01 (0.93-1.10)	0.861
PT	0.77 (0.45-1.31)	0.331
APTT	1.09 (0.99-1.19)	0.079
Platelet	0.99 (0.98-1.00)	0.082