摘要
目的探讨标准通道和微通道经皮肾镜术对血生化指标的影响。方法选择肾结石患者59例,其中标准通道29例,微通道30例。术中监测灌注前、灌注后30min、60min、90min、120min及术后4h和12h的血电解质、酸碱度(pH)、碱剩余(BE)、血肌酐(Scr)、胱抑素C(CysC)、肾小球率过滤估算值(eGFR)。结果两组间灌注时间、灌注液用量、灌注液出入差具有显著性差异(P<0.05);标准通道组术前、中、后各项指标差异均无统计学意义(P>0.05);微通道组灌注90min时,CysC显著升高,差异具有显著性(P<0.05)。灌注120min时,pH、BE、Scr及eGFR的变化具有显著性(P<0.05),但术后4h恢复到正常范围。两组间比较,灌注120min时,pH、BE、Scr及eGFR各项指标均具有显著性差异(P<0.05)。结论标准通道经皮肾镜取石术对肾结石患者血生化无明显负面影响,而长时间微通道经皮肾镜术可引起血生化明显的变化;建立通道过程中的扩张远低于灌注压对肾功能造成的损害;CysC是监测肾小球滤过率更敏感的指标,但术后短期内都可恢复到正常范围;对复杂性巨大肾结石采用较大通道为更合理的选择。
Objective To explore the changes of electrolyte balance during standard percutaneous nephrostomy （PCNL） and minimally invasive percutaneous nephrostomy （MPCNL）. Methods Fifty-nine patients with renal calculi were involved in this study, 29 cases in PCNL group, the others in MPCNL group. Serum Na＋, K＋ ,Cl-, Scr, Cystatin C, pH, base excess （BE） and estimated Glomorular fihration rate （eGFR） were detected before and after operation at different time points. Results- There was significant difference in irrigation time, irrigation volume and change of intake and output between two group. The related indexes was no significant difference in PCNL group （P〉0.05）. In MPCNL group, Cystatin C increased significantly compared with that of pre-operation at 90 minutes after irrigation （P〈0.05）, while pH, BE and eGFR decreased significantly lower than those of pre-operation, Scr were increased significantly higher than those of pre-operation at 120 minutes （P〈0.05）, but returned to the normal range 4 hours after operation. The changes of PH, BE, Scr and eGFR had statistical significant. Comparison between groups, after irrigation between two groups. Conclusions There was no significant differences in changes of electrolyte balance by long time absorption of irrigation fluid during standard percutaneous nephrostomy, but the differences may be caused during minimally invasive percutaneous nephrostomy. Renal function impairment caused by expansion in the establishment of channel process is far lower than that caused by the perfusion pressure. Serum cystatin C is a sensitive marker to reflect the renal impairment. PCNL is agood choice for complex great renal calculi.
出处
《中华腔镜泌尿外科杂志（电子版）》
2012年第5期19-23,共5页
Chinese Journal of Endourology(Electronic Edition)
基金
濮阳市科技攻关项目(项目编号:080560)
关键词
肾结石
经皮肾镜取石术
灌注液吸收
血生化
胱抑素C
Renal calculi
Percutaneous nephrostomy
Irrigation fluid absorption
Electrolyte balance
Cystatin C
