微通道和标准通道经皮肾镜碎石术对上尿路结石患者血流动力学和血气分析的影响

发布时间：2018-05-10 19:28

本文选题：经皮肾镜碎石术 + 尿路结石　；参考：《中国全科医学》2015年02期

【摘要】：目的观察微通道经皮肾镜碎石术(PCNL)和标准通道PCNL对上尿路结石患者血流动力学和血气分析的影响。方法选取2012年1月—2013年11月重庆三峡中心医院肾结石患者200例,采用随机数字表分为微通道PCNL组和标准通道PCNL组,各100例。在PCNL术中,微通道PCNL组推入F16塑料薄鞘建立经皮肾通道;标准通道PCNL组推入F24塑料薄鞘建立经皮肾通道。记录两组患者麻醉前,灌流前,灌流10、30、60、90、120 min及术后患者平均动脉压(MAP)、心率(HR)、中心静脉压(CVP);手术结束时记录灌流量和手术时间;检查血常规、静脉电解质和动脉血气分析〔包括Na+、Cl-、K+、p H、碱剩余(BE)〕。结果微通道PCNL组手术时间为(102.3±19.1)min,高于标准通道PCNL组的(83.8±15.2)min(t=7.58,P0.05);微通道PCNL组灌流液量为(21.0±1.3)L,高于标准通道PCNL组的(15.6±2.0)L(t=22.64,P0.05)。生命体征组间比较显示:两组HR、MAP和CVP在不同时间点比较,差异均无统计学意义(P0.05)。组内比较显示:两组HR不同时间点比较,差异无统计学意义(P0.05);两组灌流前MAP和CVP均低于麻醉前(P0.05);MAP和CVP在灌流10 min与灌流前比较,差异均无统计学意义(P0.05);在灌流30、60、90、120 min及术后均高于灌流前(P0.05)。动脉血气分析组间比较显示:两组Na+、Cl-、K+、p H、BE在不同时间点比较,差异均无统计学意义(P0.05)。组内比较显示:两组术后Na+、Cl-与麻醉前比较,差异无统计学意义(P0.05)。两组术后K+、p H、BE均低于麻醉前(P0.01)。两组患者术后均无尿脓毒症及其他严重并发症发生。结论随着手术时间增加,灌流液的吸收对血流动力学和动脉血气分析的影响逐渐增加;对于心、肺、肾功能正常的患者,由于器官功能的代偿,微通道PCNL与标准通道PCNL引起的灌流液吸收量的差异不足以引起患者血流动力学和血气分析的不同。
[Abstract]:Objective to observe the effects of microchannel percutaneous nephrolithotripsy (PCNL) and standard channel PCNL on hemodynamics and blood gas analysis in patients with upper urinary calculi. Methods 200 patients with renal calculi in Chongqing three Gorges Central Hospital from January 2012 to November 2013 were randomly divided into two groups: microchannel PCNL group and standard channel PCNL group. In PCNL, the percutaneous renal passage was established in the PCNL group with F16 plastic sheath and the F24 plastic sheath in the standard channel PCNL group. The mean arterial pressure (MAPP), heart rate (HR) and central venous pressure (CVP) were recorded before anesthesia and 10 030U 60C 90120 min after operation, the perfusion flow and operation time were recorded at the end of operation, and blood routine examination was performed. Analysis of venous electrolyte and arterial blood gas (including Na + Cl-K + H), alkali residue. Results the operative time of microchannel PCNL group was 102.3 卤19.1min, which was higher than that of standard channel PCNL group (83.8 卤15.2min), and the volume of perfusion fluid in microchannel PCNL group was 21.0 卤1.3mol / L, which was higher than that in standard channel PCNL group (15.6 卤2.0Lt22.64p0.05). The comparison of vital signs showed that there was no significant difference in map and CVP between the two groups at different time points (P 0.05). The results of intra-group comparison showed that there was no significant difference in HR between the two groups at different time points (P 0.05), MAP and CVP before perfusion in both groups were lower than those before anesthesia (P 0.05), map and CVP were lower than those before perfusion for 10 min and before perfusion. The difference was not statistically significant (P 0.05), and was higher than that before perfusion (P 0.05) after 30 minutes of perfusion at 90120 min and after operation. The results of arterial blood gas analysis showed that there was no significant difference between the two groups at different time points (P 0.05). The results of intragroup comparison showed that there was no significant difference between the two groups before and after operation (P 0.05). Both groups were lower than that before anesthesia (P 0.01). There were no urinary sepsis and other serious complications in both groups. Conclusion the effect of fluid absorption on hemodynamics and arterial blood gas analysis increases gradually with the increase of operation time, and for patients with normal heart, lung and kidney function, the organ function compensates. The difference of the absorption of perfusion fluid caused by microchannel PCNL and standard channel PCNL was not enough to cause the difference of hemodynamics and blood gas analysis.
【作者单位】：重庆三峡中心医院;
【分类号】：R699

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