本文選題：經(jīng)皮腎鏡碎石術(shù) + 尿路結(jié)石　； 參考：《中國全科醫(yī)學(xué)》2015年02期

【摘要】：目的觀察微通道經(jīng)皮腎鏡碎石術(shù)(PCNL)和標(biāo)準(zhǔn)通道PCNL對上尿路結(jié)石患者血流動力學(xué)和血氣分析的影響。方法選取2012年1月—2013年11月重慶三峽中心醫(yī)院腎結(jié)石患者200例,采用隨機數(shù)字表分為微通道PCNL組和標(biāo)準(zhǔn)通道PCNL組,各100例。在PCNL術(shù)中,微通道PCNL組推入F16塑料薄鞘建立經(jīng)皮腎通道;標(biāo)準(zhǔn)通道PCNL組推入F24塑料薄鞘建立經(jīng)皮腎通道。記錄兩組患者麻醉前,灌流前,灌流10、30、60、90、120 min及術(shù)后患者平均動脈壓(MAP)、心率(HR)、中心靜脈壓(CVP);手術(shù)結(jié)束時記錄灌流量和手術(shù)時間;檢查血常規(guī)、靜脈電解質(zhì)和動脈血氣分析〔包括Na+、Cl-、K+、p H、堿剩余(BE)〕。結(jié)果微通道PCNL組手術(shù)時間為(102.3±19.1)min,高于標(biāo)準(zhǔn)通道PCNL組的(83.8±15.2)min(t=7.58,P0.05);微通道PCNL組灌流液量為(21.0±1.3)L,高于標(biāo)準(zhǔn)通道PCNL組的(15.6±2.0)L(t=22.64,P0.05)。生命體征組間比較顯示:兩組HR、MAP和CVP在不同時間點比較,差異均無統(tǒng)計學(xué)意義(P0.05)。組內(nèi)比較顯示:兩組HR不同時間點比較,差異無統(tǒng)計學(xué)意義(P0.05);兩組灌流前MAP和CVP均低于麻醉前(P0.05);MAP和CVP在灌流10 min與灌流前比較,差異均無統(tǒng)計學(xué)意義(P0.05);在灌流30、60、90、120 min及術(shù)后均高于灌流前(P0.05)。動脈血氣分析組間比較顯示:兩組Na+、Cl-、K+、p H、BE在不同時間點比較,差異均無統(tǒng)計學(xué)意義(P0.05)。組內(nèi)比較顯示:兩組術(shù)后Na+、Cl-與麻醉前比較,差異無統(tǒng)計學(xué)意義(P0.05)。兩組術(shù)后K+、p H、BE均低于麻醉前(P0.01)。兩組患者術(shù)后均無尿膿毒癥及其他嚴(yán)重并發(fā)癥發(fā)生。結(jié)論隨著手術(shù)時間增加,灌流液的吸收對血流動力學(xué)和動脈血氣分析的影響逐漸增加;對于心、肺、腎功能正常的患者,由于器官功能的代償,微通道PCNL與標(biāo)準(zhǔn)通道PCNL引起的灌流液吸收量的差異不足以引起患者血流動力學(xué)和血氣分析的不同。
[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 鹵19.1min, which was higher than that of standard channel PCNL group (83.8 鹵15.2min), and the volume of perfusion fluid in microchannel PCNL group was 21.0 鹵1.3mol / L, which was higher than that in standard channel PCNL group (15.6 鹵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.
【作者單位】： 重慶三峽中心醫(yī)院;
【分類號】：R699

【參考文獻】

相關(guān)期刊論文 前3條

1 凌娜佳;黎筆熙;周翔;陶軍;;腰肋懸空體位對經(jīng)皮腎鏡碎石術(shù)老年患者血流動力學(xué)和內(nèi)環(huán)境的影響[J];華南國防醫(yī)學(xué)雜志;2011年05期

2 魏世平;潘鐵軍;楊家榮;沈國球;;腰肋懸空位和俯臥位經(jīng)皮腎鏡碎石術(shù)對患者血流動力學(xué)影響的比較[J];現(xiàn)代泌尿外科雜志;2012年02期

3 周少麗;蔡s，

本文編號：1870574