BMJ Best Practice

应急考虑

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对于血流动力学不稳定患者的紧急处理

源自尿路的危及生命的出血极其罕见，但可由于特定病因而出现，包括肾创伤、动静脉畸形出血或肾占位、胎盘穿透或出血性膀胱炎。[6] These patients require urgent evaluation in an emergency department or intensive care setting. Haemorrhagic shock from severe bleeding requires aggressive resuscitation with intravenous fluids or blood products. Emergency exploratory surgery or vascular embolisation by interventional radiology may be required for control of bleeding. Haemodynamically unstable patients with a poor response to resuscitation may require immediate intervention such as surgery or angio-embolisation in selected situations.[21] Catheterisation may be necessary, particularly if bladder distension with blood and/or urine is present. Agents such as aminocaproic acid or tranexamic acid can be used in selected situations to reduce bleeding in cases of haemorrhagic cystitis intractable to other interventions.[22]

凝血块滞留

The presence of clots in the urine indicates more significant haematuria. Blood clots can cause urinary obstruction at the bladder outlet. Irrigation of the bladder, and the possible use of continuous bladder irrigation, may be necessary to prevent clot retention and obstructive renal failure.

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