Chaix A F, Petitalot J P, Pourrat O, Barraine R, Rousseau G, Dore B
Ann Cardiol Angeiol (Paris). 1986 Feb;35(2):103-5.
The authors present a case of acute renal ischemia resulting from embolism of its main artery on the occasion of the transient interruption of anticoagulant treatment for dental extraction, in a patient bearing a Björk-Shiley valvular prosthesis in the mitral position. Its progression is marked by the complete repermeabilisation of the artery under heparin therapy with complete recuperation of renal function. This classically exceptional observation suggests that the delay occurring between the initial obstruction and repermeabilisation does not alter the degree of renal distress, the estimation of which is unpredictable. The relative resistance of the kidney to ischemia and the occurrence of efficacious fibrinolysis suggests the possibility of therapy other than surgery. Prevention demands the maintenance of coagulants under guarantee of local hemostatic processes.
作者报告了一例急性肾缺血病例,该病例发生在一名二尖瓣位植入Björk-Shiley瓣膜假体的患者因拔牙而暂时中断抗凝治疗时,其主要动脉发生栓塞。在肝素治疗下动脉完全再通且肾功能完全恢复,这标志着其病程进展。这一典型的特殊观察结果表明,初始阻塞和再通之间出现的延迟并不会改变肾损伤程度,而肾损伤程度是无法预测的。肾脏对缺血的相对耐受性以及有效纤溶的发生提示了除手术之外的其他治疗可能性。预防需要在保证局部止血过程的情况下维持抗凝剂的使用。