McGonigal M D, Lucas C E, Ledgerwood A M
J Trauma. 1987 May;27(5):471-6. doi: 10.1097/00005373-198705000-00002.
Renal function studies were performed in 275 severely injured patients with hemorrhagic shock and massive transfusion. There were 230 patients without renal injury and 45 patients with renal injury treated without exploration of the kidney in 17 patients, with exploration and renorrhaphy in nine patients, and with partial or total nephrectomy in 19 patients. In addition, 45 patients without renal injury were randomly matched by computer to the 45 patients with renal injury based on the number of blood transfusions and severity of shock as indicators of physiologic insult. Renal function was adversely affected by partial or total nephrectomy in patients with renal injury. Significant decreases in renal filtration and excretion were seen when the nephrectomy group was compared to the patients without renal injury matched for injury insult. Creatinine clearance decreased from 103 ml/min to 55 ml/min, inulin clearance from 106 ml/min to 63 ml/min, and osmolar clearance from 4.8 ml/min to 3.3 ml/min. The 230 patients without renal injury had an incidence of renal failure of 7.4% and a mortality rate of 8.2% compared to 11.4% and 15.6%, respectively, in the 45 patients with renal injury. Death and renal failure occurred in 13 of the 230 patients without renal injury (5.6%) and in two of the 45 renal injury patients (4.4%). The incidence of renal failure in the 19 patients without renal injury who died was 68% versus 29% in the seven renal injury patients who died. Preservation of renal parenchyma is recommended to provide maximal renal function in severely injured patients.
对275例严重创伤并失血性休克且接受大量输血的患者进行了肾功能研究。其中230例患者无肾损伤，45例有肾损伤，17例肾损伤患者未行肾脏探查治疗，9例行探查及肾缝合术，19例行部分或全肾切除术。此外，根据输血次数和休克严重程度作为生理损伤指标，通过计算机将45例无肾损伤患者与45例有肾损伤患者进行随机匹配。肾损伤患者行部分或全肾切除术后肾功能受到不利影响。与匹配损伤程度的无肾损伤患者相比，肾切除组的肾滤过和排泄显著降低。肌酐清除率从103 ml/min降至55 ml/min，菊粉清除率从106 ml/min降至63 ml/min，渗透清除率从4.8 ml/min降至3.3 ml/min。230例无肾损伤患者的肾衰竭发生率为7.4%，死亡率为8.2%，而45例有肾损伤患者的这两个比率分别为11.4%和15.6%。230例无肾损伤患者中有13例（5.6%）死亡和发生肾衰竭，45例有肾损伤患者中有2例（4.4%）死亡和发生肾衰竭。19例死亡的无肾损伤患者中肾衰竭发生率为68%，而7例死亡的有肾损伤患者中这一比率为29%。建议保留肾实质，以在严重创伤患者中提供最大肾功能。
