本文關(guān)鍵詞：枸櫞酸氫鉀鈉顆粒用于雙J管植入后預(yù)防管壁結(jié)石形成臨床研究　出處：《吉林大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 枸櫞酸氫鉀鈉 腎結(jié)石 輸尿管結(jié)石 D-J管

【摘要】：背景:輸尿管支架管自從其問世以來在泌尿外科領(lǐng)域應(yīng)用越來越廣泛,已經(jīng)成為泌尿外科不可缺少的幫手。但因其為尿路中的異物,其臨床并發(fā)癥也較多,其中管壁形成結(jié)石為臨床上較為棘手的問題,有些患者形成結(jié)石的量大,造成拔管困難,甚至需要開放手術(shù)處理,給患者造成很大的心里及經(jīng)濟(jì)負(fù)擔(dān)。然而臨床至今仍然沒有較好的預(yù)防管壁形成結(jié)石的方法。本研究試圖通過運(yùn)用枸櫞酸氫鉀鈉顆粒預(yù)防管壁結(jié)石形成,希望找到預(yù)防管壁成石的方法,為廣大患者減少病痛,同時也能更好的服務(wù)于臨床工作。目的:探討枸櫞酸氫鉀鈉顆粒用于預(yù)防雙J管壁結(jié)石形成的療效。方法:60名患者均為輸尿管支架管植入術(shù)后,均為腎結(jié)石或輸尿管結(jié)石術(shù)后且術(shù)中結(jié)石清楚徹底,術(shù)后行腹部KUB示雙J管位置良好,支架管均為bard進(jìn)口同樣材質(zhì),型號為F6。30名患者口服枸櫞酸氫鉀鈉,其中男性18名,女性12名,每日10g,分三次口服,并根據(jù)尿液PH值調(diào)整用藥劑量。對照組30名患者男性20名,女性10名,雙J管留置1-3個月(輸尿管無狹窄、水腫者留置1個月;輸尿管狹窄者留置3個月,其余留置2個月)在膀胱鏡下拔出,由兩名有經(jīng)驗(yàn)的臨床醫(yī)師觀察管壁上結(jié)石形成量,我們將實(shí)驗(yàn)結(jié)果分為以下級別:A.管壁顏色沒有變化我們視為沒有結(jié)石形成;B.管壁上肉眼看不到結(jié)石但管壁顏色有變化,用手可以搓出尿垢沉積物;C.管壁上可以看到明顯結(jié)石;D.管壁上大量結(jié)石形成,膀胱鏡下無法拔出支架管。結(jié)果:實(shí)驗(yàn)組中A級別患者為25人,B為2人,C為3人,D為0人,對照組A級別為17人,B級別為6人,C級別為7人,D級別為0人。結(jié)論:服用枸櫞酸氫鉀鈉顆�？擅黠@減少留置支架管患者術(shù)后管壁結(jié)石形成,該藥的主要成分是枸櫞酸根離子,口服后可增加尿液PH值和枸櫞酸根的排泄。枸櫞酸根是尿中最豐富的陰離子,也是鈣性結(jié)石的重要抑制因子,它可直接抑制結(jié)晶形成的所有過程,包括抑制結(jié)晶的成核、生長和聚集;并可與尿鈣結(jié)合形成溶解度較高的枸櫞酸一鈣結(jié)合物,從而降低尿中鈣離子的濃度,使尿草酸鈣的飽和度較低,間接抑制了結(jié)晶的形成;同時PH的升高可以增加尿酸結(jié)石和胱氨酸結(jié)石的可溶性。達(dá)到抑制結(jié)石的目的。建議留置支架管患者規(guī)律口服枸櫞酸氫鉀鈉顆粒。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R699

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