单侧经皮肾镜碎石取石术对患者血压影响的前瞻性研究  

Prospective study on blood pressure changes after unilateral percutaneous nephrolithotomy

作　　者：李守宾[1] 李双利[2] 马建锋[3] 沙泉[3] 邢爱君[4] 李连印[2] 温英武[2] 高双友[2] LI Shoubin;LI Shuangli;MA Jianfeng;SHA Quan;XING Aijun;LI Lianyin;WEN Yingwu;GAO Shuangyou(Department of Urology,Hebei General Hospital,Shijiazhuang,050051,China;Department of Urology,Kailuan General Hospital;Department of Urology,Baoding No.1 Hospital;Department of Cardiology,Kailuan General Hospital)

机构地区：[1]河北省人民医院泌尿外科,石家庄050051 [2]开滦总医院泌尿外科 [3]保定市第一医院泌尿外科 [4]开滦总医院心内科

出　　处：《临床泌尿外科杂志》2018年第7期571-574,共4页Journal of Clinical Urology

基　　金：河北省科技厅指令性计划项目(编号14277734D)

摘　　要：目的:前瞻性研究单侧经皮肾镜碎石取石术(PCNL)对患者血压的影响。方法:对符合入组标准并接受单侧PCNL的69例患者,按患者术前有无高血压分为高血压组和非高血压组,分别于术前、术后3个月、6个月、1年测量血压,同时化验肾素、血管紧张、素醛固酮,对结果进行分析。结果:高血压组患者的术前、术后3个月、术后6个月、术后1年平均收缩压分别为(141.76±9.68)mmHg、(123.85±10.20)mmHg、(131.91±8.79)mmHg、(139.12±11.31)mmHg;平均舒张压分别为(86.47±7.74)mmHg、(73.38±7.66)mmHg、(83.53±5.65)mmHg、(90.74±8.45)mmHg。与术前比较,患者术后3个月时的血压明显下降(P<0.05),但术后血压逐渐回升,术后1年时舒张压高于术前水平(P<0.05),收缩压无明显变化。非高血压组患者的收缩压在各个时期无明显变化,舒张压也在术后3个月时下降,之后逐渐回升,但与术前比较差异无统计学意义(P>0.05)。所有患者的肾素水平无明显变化;血管紧张素和醛固酮水平在术后3个月时明显降低,之后逐渐回升,术后1年时较术前水平略高。结论:PCNL会对高血压患者的血压产生影响,短期内血压下降,然后逐渐回升到术前水平,术后1年时舒张压较术前明显升高。血压的变化可能与肾素血管紧张素系统的激活有关。Objective：To investigate the impact of unilateral percutaneous nephrolithotomy on patient＇s blood pressure by aprospective clinical trial.Method：Sixty-nine patients matched the inclusion criteria of this study were prospectively evaluated.Blood pressure and levels of serum renin angiotensin aldosterone were followed up before procedure,and at the 3 rd,6 th,12 th month after procedure.And then all the data were collected and analyzed.Result：Average systolic blood pressure values of subjects with hypertension were（141.76±9.68）mmHg,（123.85±10.20）mmHg,（131.91±8.79）mmHg,（139.12±11.31）mmHg before procedure,at the 3 rd,6 th,and 12 th month after procedure respectively;while average diastolic blood pressure were（86.47±7.74）mmHg,（73.38±7.66）mmHg,（83.53±5.65）mmHg,（90.74±8.45）mmHg at the corresponding time point.The average blood pressure decreased significantly at 3 rd month after procedure,compared to pre-procedure level（P〈0.05）,and then climbed back gradually.Besides,there was an increasing level of diastolic pressure at 12 th month after procedure compared with preoperative level（P〈0.05）;while there was no difference in systolic blood pressure between 12 th month after procedure and pre-procedure.In the patients without hypertension,there were no significant changes in average systolic blood pressure;a dramatic decline was seen in average diastolic blood pressure at 3 rd month,but there was no significant difference compared to pre-procedure.There was no significant change in the level of renin.The level of angiotensin and serum aldosterone deceased significantly at 3 th month,but rose again to a higher level than before at 12 th month.Conclusion：Percutaneous nephrolithotomy can influence the blood pressure in patients with hypertension,which decreased significantly in short post-operative period,and then returned to pre-procedure level.At 12 th month after procedure,the average diastolic pressure was significantly higher than pre-procedure.The activation of

关 键 词：经皮肾镜碎石取石术 血压 肾素-血管紧张素-醛固酮系统 

分 类 号：R692.4[医药卫生—泌尿科学]