无管化经皮肾镜取石术患者的护理研究  

The Nursing Care of Patients with Tubeless Percutaneous Nephrolithotomy

作　　者：刘丽欢[1] 陈美珠[1] 梁晓燕[1] 孙红玲[1] 邱玲[1] 刘永达[1] 肖成林[1] 

机构地区：[1]广州医学院第一附属医院微创外科中心泌尿外科,广州市510120

出　　处：《中华全科医学》2013年第8期1314-1315,共2页Chinese Journal of General Practice

摘　　要：目的调查无管化经皮肾镜取石术(tubeless percutaneous nephrolithotomy,tubeless PCNL)患者在围手术期的状况,探讨tubeless PCNL术前的护理方法,减少并发症的发生。方法分析2010年6月-2012年5月98例行tubelessPCNL治疗上尿路结石的临床资料,主要包括:手术时间、支架管留置时间、结石位置、血红蛋白、尿路感染、血压、体温、并发症等。结果手术时间60～110 min(平均95 min),输尿管支架留置时间1～8 d(平均2 d),患者术后的HB下降,与术前比较,差异有统计学意义(P<0.01),下盏、铸形石患者的术前发生尿路感染、多发结石机会比上盏、输尿管石患者的多,差异有统计学意义(P<0.01)。患者手术日晨7:00体温低于术后当天19:00体温,手术日7:00的舒张压高于术后当天19:00的舒张压,经配对t检验比较,差异有统计学意义(P<0.05)。结论笔者认为无管化PCNL患者的护理,全程评估患者身体状况是选择无管化PCNL的前提,术后监控输尿管外支架的引流是护理的重点,控制感染是无管化PCNL成功的关键。Objective To investigate the perioperative conditions of patients who underwent tubeless percutaneous nephrolithotomy（tubeless PCNL）,and explore the nursing method of preoperative tubeless PCNL aiming to reduce the rate of perioperative complications.Methods A total of 98 patients with upper urinary stones who underwent tubeless PCNL during June 2010 and May 2012 were analyzed retrospectively.The clinical data such as operation time,indwelling time of ureteral stents,stone location,haemoglobin,urinary tract infections,blood pressure,body temperature and complications were included.Results Of all 98 patients,the operation time was 60-110 min（average 95 min）,indwelling time of ureteral stents was 1-8 days（average 2 days）.The postoperative HB decreased significantly compared with the preoperative HB（P〈0.01）,patients with lower calyx stones and cast stones presented higher rate of urinary tract infection and multiple stones incidence than patients with upper calyx stones and ureteral stones,and the difference was statistically significant（P〈0.01）.The preoperative（7： 00 of the day of surgery） body temperature was lower than that of the postoperative（19： 00 of the day of surgery）,and the difference was statistically significant（P〈0.05）.Conclusion A full assessment of the patient’s physical condition was a premise of tubeless PCNL,monitoring ureter external stent drainage was the focus of postoperative nursing care,and controlling infection after tubeless PCNL was the key to success.

关 键 词：上尿路结石 无管化PCNL 并发症 护理 

分 类 号：R473.6[医药卫生—护理学] R699.4[医药卫生—临床医学]