Risk factors for large hematoma complication caused by percutaneous renal biopsy which guided by ultrasound and related nursing care
10.3760/cma.j.issn.1672-7088.2019.29.005
- VernacularTitle: 超声引导下经皮肾穿刺活检术后中度肾血肿形成的危险因素分析及护理
- Author:
Ting HU
1
,
2
;
Hongmei ZHANG
3
;
Jiazhen YIN
3
;
Xuanli TANG
3
;
Zhengxian ZHANG
4
;
Wei WANG
1
Author Information
1. Nursing Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
2. Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
3. Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
4. Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, China
- Publication Type:Clinical Trail
- Keywords:
Renal biopsy;
Large hematoma;
Risk factor
- From:
Chinese Journal of Practical Nursing
2019;35(29):2263-2268
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors for large renal hematoma caused by percutaneous renal biopsy (PRB) in order to provide evidence for early clinical prevention and Effective nursing.
Methods:The data of 707 patients who underwent PRB in nephrology department in Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to January 2017 were retrospectively identified. Demographic and clinical data were collected, including general status (gender, age, body mass index, histological diagnosis, associated diseases), laboratory indexes and related examination during PRB (serum creatinine, estimated glomerular filtration rate, creatinineclearance rate, serumuricacid, serumalbumin, hemoglobin, platelet count, prothrombin time, activated partial thromboplastin time, kidney size), blood pressure(history of hypertension, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure before PRB). Univariable logistic regression analysis, linear diagnosis, factor analysis, multivariable logistic regression analysis and receiver operating characteristic curve (ROC curve) were used to assess risk factors.
Results:Over the period, 707 native kidney biopsies were performed. Hematoma occurred in 609 biopsies (86.1%), including 558 minorhematomacases (78.9%), 51 largehematoma cases (7.2%), no severe complications were observed. Univariable logistic regression analysis of risk factors in 51 patients with large hematoma after PRB found that there were significant differences in renal tubulointerstitial fibrosis, crescents > 25%, serum creatinine, history of hypertension, systolic blood pressure, diastolic blood pressure and mean arterial pressure before PRB (P< 0.05). Compared with the non-hematoma/minor-hematoma group, the blood pressure before PRB increased significantly in large hematoma group (OR=1.414, 95%CI=1.007-1.985, P=0.045) . More patients with a history of hypertension in large hematoma group (OR=1.997, 95% CI=0.995-4.009, P=0.052) .The area under the ROC curve for predicting large hematoma after PRB was 0.634 for blood pressure before PRB and history of hypertension, the Youden index was 0.27. The blood pressure before PRB and hypertension history were used to predict the formation of large hematoma separately, and the Youden index was 0.28 vs. 0.22 (P> 0. 05).
Conclusions:History of hypertension and blood pressure before PRB were independent risk factors for large renal hematoma after PRB.Patients with history of hypertension were more likely to develop large hematoma than those with no history of hypertension, and those with higher blood pressure before PRB were more likely to develop large hematoma. The history of hypertension and the blood pressure before PRB have certain effect in predicting the formation of large hematoma after PRB. Each of them have a certain predictive effect on the formation of largehematoma after PRB, and the prediction effect trend of blood pressure before PRB is slightly better than that of history of hypertension.
