经皮肾镜取石术灌注液对患者机体的影响  

Effects of irrigating fluid absorption in percutaneous nephrolithotripsy

作　　者：任明华[1] 倪少滨[1] 陈起引[1] 王长林[1] 付宜鸣[1] 焦治兴[1] 麻立[1] 赵忠山[1] 段永顺[1] 

机构地区：[1]哈尔滨医科大学附属第一医院泌尿外科,150001

出　　处：《中华医学杂志》2010年第4期225-227,共3页National Medical Journal of China

摘　　要：目的观察经皮肾镜取石术（PCNL）中以0．9％生理盐水为灌注液时机体的血液动力学变化、电解质变化、术中术后并发症的发生与灌注时间之间的关系。方法肾结石患者68例，其中男31例，女37例。体位均为侧卧位，在超声引导下行经皮肾镜钬激光碎石术。记录平均动脉压、心率、中心静脉压、血红蛋白、Na^＋、K^＋、Cl^＋离子变化；手术中液体灌注的时间、术中和术后并发症的产生及变化。结果（1）术中及术后情况：平均手术灌注时间（83．10±22．21）min，其中2例患者因穿刺后出血而停止于术，流置造瘘管行二期钬激光碎石。11例患者术中出血较多，输血及密切监测下继续碎石；其中两例发生心衰前兆而终止手术，9例需术后输血。术后18例病人体温高于37．5℃，其中1例病人术后造瘘管及管周出血，1周后出现肾周感染：（2）观察指标变化：在液体灌注前后患者的平均动脉压、心牢、血红蛋白、Na^＋、K^＋、Cl^＋离子均未见显著性变化（P〉0．05）。患者的中心静脉压（CVP）由液体灌注前的（11．13±1．66）cm H2O （1 cm H2O=0．098kPa）提高到灌注后的（12．00±1．67）cm H2O（P〈0．05），在出血较多和手术时间较长的病例尤为明显，术中及术后给速尿静推后有所缓解。术后发热组的术中平均灌注时间比不发热组要长（P〈0．05），发热组的CVP比不发热组要高（P〈0．05）。结论在用0．9％生理盐水为灌注液时，短时间内的灌注是相对安全的，但在时间较长、出血较多的病例易发生术中心衰及术后的感染发热。Objective To determine the hemodynamic status, fluid-electrolyte changes and complications associated with irrigation time in percutaneous nephrolithotripsy. Methods A total of 68 renal calculi patients （31 males and 37 females） were recnlited. The lateral recumbent percutaneous nephrolithotripsy was operated with Ho laser under ultrasonic; guidance. 0. 9% NaCI was used as perfusion fluid. The following items were recorded： mean arterial blood pressure（MAP）, heart rate, central venous pressure （CVP）, hemoglobin, sodium, potassium and chloride; perfusion time during operation; pert- operative and post-operative complications. Results （ 1 ） Pert-operative and post-operative conditions： the average operative time was 83. 1 ± 22.21 minutes. Two eases stopped because of bleeding after puncture and the tube of stoma was plaeed for stone clearance of the second time. There was more bleeding in 11 patients, but the operations were continued with blood transfusion and close monitoring. Two operations ceased because of a premonition of congestive heart failure. Nine patients needed post-operative blood transfusion and 18 had a post-operative fever. One patient bled in and around the tube and had a peri-renal infection a week laler. （2）Changes of observation parameters： there was no significant difference in CVP, heart rate, hemoglobin, sodium, potassium and chloride （ P 〉 0. 05 ）. The post-per＇fusion value of MAP increased （P 〈 0. 05） especially in the eases of more bleeding and long time of irrigation. Pert-operative and post-operative injection of furosemide could reduce the CVP value. The average irrigation time in the fever group was longer than the non-fever group（ P 〈 0. 05）and the CVP value of the fever group was higher than the non-fever group（ P 〈 0. 05 ）. Conclusion Low pressure and short time of perfusion are safe in clinical practice. Congestive heart failure after the perfusion and the occurrence of post-operative infections are difficult to avoid when there

关 键 词：经皮肾镜碎石术 灌注液 中心静脉压 发热 

分 类 号：R699[医药卫生—泌尿科学]