枸橼酸氢钾钠颗粒用于双J管植入后预防管壁结石形成临床研究

发布时间：2017-12-31 01:01

本文关键词：枸橼酸氢钾钠颗粒用于双J管植入后预防管壁结石形成临床研究　出处：《吉林大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:输尿管支架管自从其问世以来在泌尿外科领域应用越来越广泛,已经成为泌尿外科不可缺少的帮手。但因其为尿路中的异物,其临床并发症也较多,其中管壁形成结石为临床上较为棘手的问题,有些患者形成结石的量大,造成拔管困难,甚至需要开放手术处理,给患者造成很大的心里及经济负担。然而临床至今仍然没有较好的预防管壁形成结石的方法。本研究试图通过运用枸橼酸氢钾钠颗粒预防管壁结石形成,希望找到预防管壁成石的方法,为广大患者减少病痛,同时也能更好的服务于临床工作。目的:探讨枸橼酸氢钾钠颗粒用于预防双J管壁结石形成的疗效。方法:60名患者均为输尿管支架管植入术后,均为肾结石或输尿管结石术后且术中结石清楚彻底,术后行腹部KUB示双J管位置良好,支架管均为bard进口同样材质,型号为F6。30名患者口服枸橼酸氢钾钠,其中男性18名,女性12名,每日10g,分三次口服,并根据尿液PH值调整用药剂量。对照组30名患者男性20名,女性10名,双J管留置1-3个月(输尿管无狭窄、水肿者留置1个月;输尿管狭窄者留置3个月,其余留置2个月)在膀胱镜下拔出,由两名有经验的临床医师观察管壁上结石形成量,我们将实验结果分为以下级别:A.管壁颜色没有变化我们视为没有结石形成;B.管壁上肉眼看不到结石但管壁颜色有变化,用手可以搓出尿垢沉积物;C.管壁上可以看到明显结石;D.管壁上大量结石形成,膀胱镜下无法拔出支架管。结果:实验组中A级别患者为25人,B为2人,C为3人,D为0人,对照组A级别为17人,B级别为6人,C级别为7人,D级别为0人。结论:服用枸橼酸氢钾钠颗粒可明显减少留置支架管患者术后管壁结石形成,该药的主要成分是枸橼酸根离子,口服后可增加尿液PH值和枸橼酸根的排泄。枸橼酸根是尿中最丰富的阴离子,也是钙性结石的重要抑制因子,它可直接抑制结晶形成的所有过程,包括抑制结晶的成核、生长和聚集;并可与尿钙结合形成溶解度较高的枸橼酸一钙结合物,从而降低尿中钙离子的浓度,使尿草酸钙的饱和度较低,间接抑制了结晶的形成;同时PH的升高可以增加尿酸结石和胱氨酸结石的可溶性。达到抑制结石的目的。建议留置支架管患者规律口服枸橼酸氢钾钠颗粒。
[Abstract]:Background: ureteral stents have been widely used in the field of urology since they were invented, and have become an indispensable assistant in urology. However, because they are foreign bodies in the urinary tract, their clinical complications are more and more. Among them, the formation of stones in the wall of the tube is a more difficult clinical problem, and some patients have a large amount of stones, resulting in difficult extubation, and even need to be treated by open surgery. This study attempts to prevent the formation of wall stones through the use of potassium citrate granules. Hope to find a way to prevent the formation of stone tube wall for the majority of patients to reduce the pain. Objective: to evaluate the efficacy of potassium citrate granules in preventing the formation of double J wall stones. Methods: 60 patients were treated with ureteral stents. All of them were renal calculi or ureteral calculi and the stones were clear and thorough during operation. Abdominal KUB showed that the double J tubes were in good position and the stent tubes were all of the same material as the inlet of bard. Model F 6.30 patients with oral sodium hydrogen potassium citrate, including 18 men, 12 women, 10g daily, in three oral doses. The dosage was adjusted according to the PH value of urine. In the control group, 20 patients were male and 10 were female. The double J tube was kept for 1-3 months (ureter without stenosis and edema for 1 month). Ureteral strictures were retained for 3 months and the rest for 2 months) pulled out under cystoscope and observed by two experienced clinicians. We divided the results into the following levels: A. there was no change in the color of the tube wall, and we considered that there was no stone formation. B. the stone is invisible to the naked eye on the tube wall, but the color of the tube wall is changed, the urine dirt deposit can be rubbed by the hand; C. obvious stones can be seen on the wall; The stents could not be pulled out by cystoscope. Results: in the experimental group, 25 patients were in grade A patients, 2 patients were in grade A patients, 2 patients had stones on the wall of the tube, and 0 patients were in the control group, and 17 patients had grade A patients in the control group. Conclusion: taking potassium citrate granules can significantly reduce the formation of wall stones in patients with indwelling stents. The main component of this drug is citrate ion. After oral administration, the PH value of urine and the excretion of citrate are increased. Citrate is the most abundant anion in urine and an important inhibitor of calcium stone. It can directly inhibit all the processes of crystallization. Including inhibition of crystallization nucleation, growth and aggregation; It can combine with urine calcium to form calcium citrate conjugate with high solubility, thus reducing the concentration of calcium ion in urine, making the saturation of calcium oxalate in urine lower, and indirectly inhibiting the formation of crystallization. At the same time, the increase of PH can increase the solubility of uric acid stone and cystine stone, and achieve the purpose of inhibiting stone. It is suggested that patients with indwelling stent tube take orally sodium hydrogen potassium citrate granules regularly.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R699

【参考文献】