摘要
目的:比较分析输尿管软镜碎石术(URL)、微创经皮肾镜取石术(MPCNL)、体外冲击波碎石术(ESWL)治疗对上尿路结石患者血流动力学及血气指标的影响。方法:选取2013年8月至2015年10月四川省自贡市第四人民医院收治的300例肾结石患者为研究对象,按照随机数字表法分为URL组、MPCNL组及ESWL组,每组各100例。记录并比较3组患者的手术时间、手术成功率、住院时间及术后发热情况;麻醉前、灌流前、灌流1h及术后的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP);麻醉前、灌流前、术后的Na+、Cl-、K+、pH值及碱剩余(BE)。结果:ESWL组手术时间显著低于URL组(P<0.05),手术时间及住院时间显著低于MPCNL组,而手术成功率也显著低于其他两组(P<0.05);MPCNL组的手术时间及住院时间均显著低于URL组(P<0.05)。3组患者组间的各项血流动力学指标和血气分析指标比较,差异均无统计学意义(均P>0.05),3组患者在不同时间点的HR、Na+和Cl-比较差异无统计学意义(P>0.05),而灌流前MAP、CVP以及K+、pH值、BE水平均低于麻醉前,差异有统计学意义(P<0.05)。此外,ESWL组的术后发热率显著低于URL和MPCNL组(P<0.05)。结论:URL、MPCNL及ESWL均能有效地清除上尿路结石,3者手术时间递减,但对于肾、心、肺功能正常的患者,其血气分析与血流动力学并无明显差异。
Objective： To investigate the effects of ureteroscopic lithotripsy （U R L ）, minimally invasive percutaneousnephrolithotomy （M PCNL） and extracorporeal shock wave lithotripsy （ESW L） on hemodynamicsand blood gas indexes in patients with upper urinary tract calculi. Methods： 300 patients with upper urinarytract calculi in our hospital from August 2013 to October 2015 were recruited and divided into theURL, MPCNL and ESWL groups （100 cases in each group）. The duration of operation, the success rate ofsurgery, duration of hospitalization and the postoperative body tem perature were recorded and compared amonggroups. Heart rate （HR ） , mean arterial pressure （M AP） and central venous pressure （CVP） as wellas blood gas indexes including the electrolyte levels （Na , Cl , K ） , pH value and base excess （BE） weredetermined at pre-anesthesia, pre-perfusion, 1 h postperfusion and postoperation. Results： The duration ofoperation and the success rate of surgery in ESWL group were significantly lower than those in URL groupand MPCNL group （ P 〈0. 05）. The duration of hospitalization was significantly lower than that in MPCNLgroup （ P 〈0. 05）. The duration of operation and hospitalization in MPCNL group were significantlylower than those in the URL group （ P 〈0. 05）. There was no significant difference among three groups inthe hemodynamic parameters and blood gas indexes （ P〉0. 05）. There was also no significant difference inthe H R , Na and Cl levels at different time points among groups （ P 〉 0 . 05） , but the M A P,CV P, K level, pH value and BE at pre-perfusion weremarkedly lower than those at pre-anesthesia （ P〉0. 05）. M oreover, the postoperative fever rate of ES
WL group was significantly lower than that of URL group and MPCNL group （ P 〈0. 05）. Conclusion ：URL, MPCNL and ESWL can effectively remove the upper urinary tract calculi, and URL shows the shortestoperation time. There was no significant difference in blood gas indexes and
出处
《广西医科大学学报》
CAS
2016年第4期661-664,共4页
Journal of Guangxi Medical University
关键词
输尿管镜碎石术
微创经皮肾镜取石术
体外冲击波碎石术
血流动力学
血气指标
ureteroscopy lithotripsy
minimally invasive percutaneous nephrolithotomy
extracorporeal shock wave lithotripsy
hemodynamics
blood gas indexes
