软镜碎石术中肾内压监测的方法及意义(附13例报告)  

Technique and clinical significance of intrarenal pressure monitoring during flexible ureteroscopic lithotripsy(a report of 13 cases)

作　　者：段康[1] 刘齐贵[1] 王跃力[1] 夏福林[1] 张新元[1] 段娟[1] 邝丽新[1] 郭蕾[1] 李坤林[1] 

机构地区：[1]昆明医科大学附属成都军区昆明总医院泌尿外科,昆明650032

出　　处：《西南国防医药》2016年第2期126-129,共4页Medical Journal of National Defending Forces in Southwest China

基　　金：成都军区昆明总医院院长基金专项资助(2012YG01)

摘　　要：目的回顾性分析输尿管软镜碎石术中直接监测肾内压的方法及对手术的意义。方法 13例肾结石患者在输尿管软镜碎石术前,对手术侧输尿管进行为期2 w的预扩张,然后返院行输尿管软镜碎石术。术中设定灌注泵流量为0.2 L/min,灌注压力上限为100 mm Hg。使用动脉压监测仪通过输尿管推送鞘副通道直接监测术中肾盂内压力变化,术后观察有无并发症发生。结果 13例术中均测压成功,全部患者在预先设定灌注流量及灌注压力上限情况下完成手术。术中初始肾内压9~53（22.23±11.38）mm Hg;最高肾内压20~66（30.23±12.44）mm Hg,其中1例平均肾内压〉30 mm Hg。结论此测压方法无需对肾脏进行穿刺即可实时监测肾内压力变化情况,术者可根据肾内压力变化及时调节液体灌注流量,从而避免术后出现发热、尿源性脓毒血症等并发症。该测压方法可适用于所有输尿管软镜肾内操作技术,进一步提高了该技术的安全性。Objective To retrospectively analyze the technique and clinical significance of direct intrarenal pressure monitoring during flexible ureteroscopic lithotripsy. Methods Thirteen patients with renal calculi received the two-week predilation of the ureters at the operative sides before the flexible ureteroscopic lithotripsy. During the lithotripsy, the perfusion pump capacity was 0.2 L/min, and the upper limit of pertusion pressure was 100 mmHg. Arterial blood pressure monitor was used to push the patent ureteral access sheath （UAS） via ureters to monitor the renal pelvis internal pressure during the operation. Alter the operation, observation was made in whether there were complications, Results The pressure was successfully detected in all the 13 cases. Those patients completed the operation under the presetting of perfusion capacity and pressure. During the operation, the incipient intrarenal pressure was 9-53 mmHg, and the average was （22.23±11.38） mmHg. The maximum renal pelvia internal pressure pelvic pressure was 20-66 mmttg, and the average was （30.23±12.44） mmHg. There was one case with the average larger than 30 mmHg. Conehulion This monitoring method can detect tile intrarenal pressure changes without the kidney puncture. Patients＂ perfusion capacity can be adjusted according to the intrarenal pressure changes so that postoperative complications like fever and urosepsis can be avoided. This method can be applied to all the flexible ureteroscupic techniques, which further improves the safety of this technology.

关 键 词：输尿管软镜 肾内压 肾结石 监测 方法 

分 类 号：R693.4[医药卫生—泌尿科学]