超声引导下经皮注射凝血类药物对经皮肾穿刺活检出血止血效果的研究

林艳端; 李锐; 傅巧敏; 陈江华; 黎坤俭; 周小峰; 陈卉品

doi:10.3969/j.issn.1671-2390.2024.05.003

超声引导下经皮注射凝血类药物对经皮肾穿刺活检出血止血效果的研究

Effect of percutaneous injection of hemostatic agents guided by ultrasound for arresting active hemorrhage after renal biopsy

摘要

摘要:
目的探讨超声引导下经皮注射凝血类药物对经皮肾穿刺活检出血的止血效果。
方法回顾性分析2019 年 1 月至 2022 年 12 月在厦门大学附属中山医院超声医学科行超声引导下经皮肾穿刺活检的600例患者中出现的沿针道活动性出血且经手法压迫10 min无法止血的10例患者，其中5例采用超声引导下沿穿刺针道经皮注射白眉蛇毒血凝酶，5例采用超声引导下经皮注射凝血酶进行局部止血，所有患者在注射凝血类药物前均通过超声或超声造影明确出血部位，随即在超声引导下经皮准确注射凝血类药物到出血部位进行局部止血治疗，注射后超声或超声造影即刻评价止血效果。
结果 10例经皮肾穿刺活检后出血的患者在超声引导下沿穿刺针道经皮注射凝血类药物至出血部位后，最终均实现了有效的局部止血，其中1例在注射白眉蛇毒血凝酶后超声检查发现针道出血仍然存在，最终通过追加注射凝血酶实现有效的局部止血。
结论超声引导下经皮注射凝血类药物在经皮肾穿刺活检后出现针道活动性出血的止血治疗中具有快速、精准、有效、简便、可重复且无放射性等优点，有望成为经皮肾穿刺活检后出血的一种新的有效的床旁即可操作的止血方法，同时考虑到两种凝血类药物的不同安全性，凝血酶误入血管容易引起血栓，在面对经皮肾穿刺活检后针道的活动性出血时可优先选用安全性更高的白眉蛇毒血凝酶进行局部止血，当出血量较大血凝酶无法止血时再更换止血强度较大的凝血酶进行止血。

Abstract:
Objective To evaluate the clinical application of percutaneous injection of hemostatic agents guided by ultrasound for arresting active hemorrhage after renal biopsy.
Methods From January 2019 to December 2022, 10 cases of active hemorrhage after renal biopsy on ultrasound were retrospectively examined. Hemorrhage continued despite simple compression and it was treated by a percutaneous injection of hemostatic agents under ultrasonic guidance. Then hemostatic outcomes were also evaluated by ultrasound.
Results Ultrasound could detect the hemorrhagic site to enable an accurate injection of hemostatic agents. After injection, there was no active hemorrhage.
Conclusions Percutaneous injection of hemostatic drugs guided by ultrasound for arresting active hemorrhage after renal biopsy offer the advantages of rapid, accurate, effective, simple, repeatable and non-radioactive. This technique is a novel alternative for bedside immediate management of active hemorrhage after renal biopsy. At the same time, considering the safety of two kinds of hemostatic agents, hemocoagulase may be preferentially selected for local hemostasis of active hemorrhage after renal biopsy. When hemocoagulase fails to control active hemorrhage, thrombin can be replaced for hemostasis.

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