肾结石ESWL治疗中不良反应原因分析及对策研究  

A study on the adverse effects of extracorporeal shockwave lithotripsy （ESWL） for renal stones

作　　者：王曦堃[1] 王友志[1] 谷艳辉[1] 许长宝[1] 王鹏森[1] 

机构地区：[1]郑州大学第二附属医院泌尿外科,450014

出　　处：《中华泌尿外科杂志》2016年第8期578-582,共5页Chinese Journal of Urology

摘　　要：目的 对体外冲击波碎石术（ESWL）治疗肾结石过程中出现不良反应的原因进行分析并探讨防治措施.方法 回顾性分析我院2015年4-12月行ESWL治疗的165例肾结石患者的临床资料,所有患者均仰卧位,冲击波方向经由前腹部入路,观察患者在ESWL治疗中是否出现不良反应,采用非条件Logistic回归对影响不良反应发生的相关因素进行统计学分析.结果 165例中70例（42.4％）出现震区疼痛,10例（6.1％）出现冷汗,8例（4.8％）出现心率加快,5例（3.0％）出现心率减慢,2例（1.2％）出现恶心、呕吐.单因素Logistic回归分析共4个变量（体重指数、ESWL治疗史、结石位置、碎石能量）有统计学意义.将以上变量代入多因素Logistic回归分析,结果显示最终对不良反应的影响有统计学意义的因素有：体重指数＜ 24.0 kg/m^2（OR =4.155,CI1.373 ～ 12.571）、有ESWL治疗史（OR=0.163,CI0.058 ～0.454）、肾盂结石（OR=123.051,CI17.638～858.439）、肾中盏结石（OR=169.171,CI29.677 ～ 964.343）、碎石能量86.3 ～ 94.7J（OR=0.094,CI0.025 ～0.362）.结论 疼痛为ESWL治疗中最常见的不良反应.结石位置（肾盂结石、中盏结石）、体重指数（BMI＜24.0 kg/m^2）为ESWL治疗中影响不良反应发生的危险因素,其中结石位置为独立危险因素;有ESWL治疗史、碎石能量86.3 ～ 94.7J为影响不良反应发生的保护因素.Objective To study the reason and the preventive measures that adverse effects of extracorporeal shockwave lithotripsy （ESWL） for renal stones during treatment.Methods From April 2015 to January 2016,165 patients who underwent ESWL treatment for renal stones were enrolled this retrospective study.All patients were in supine position.Direction of shockwave was by the path of preabdomen.The adverse effects during treatment were observed.The related factors were analyzed by Logistic regression analysis.Results There were 70 cases（42.4%） with pain,10 cases（6.1%） with cold sweat,8 cases （4.8%） with accelerated heart rate,5 cases （3.0%）with descent of heart rate,2 cases （1.2%） with nausea and vomiting.In the univariate Logistic regression analysis,four variables （BMI,history of ESWL treatment,stone location and energy） were found showing statistical significance.Multivariate Logistic regression analysis showed that the final significant related factors were BMI 〈 24.0 kg/m^2 （OR =4.155,CI 1.373-12.571）,history of ESWL treatment （OR =0.163,CI 0.058-0.454）,stone in pelvis（OR =123.051,CI 17.638-858.439）,stone in middle calyceal （OR =169.171,CI 29.677-964.343）,energy 86.3-94.7J （OR =0.094,CI 0.025-0.362）.Conclusions Pain was the most common adverse effect during the treatment of ESWL.Stone location （pelvis and middle calyceal） was an independent risk factor,BMI 〈 24.0 kg/m^2 was one of the related risk factors.Both energy 86.3-94.7J and history of ESWL treatment were preventive factors.

关 键 词：体外冲击波碎石 疼痛 不良反应 危险因素 防治措施 

分 类 号：R699.2[医药卫生—泌尿科学]