乙醇法监测经皮肾镜取石术中灌流液吸收量的临床研究

Monitoring the irrigating fluid absorption during percutaneous nephrolithotomy by ethanol method

目的 探讨减少经皮肾镜取石术（PCNL）中灌流液吸收量的途径.方法 PCNL患者20例.男13例,女7例.平均年龄40（25～56）岁.结石最大径平均25（18～36）mm.术中使用乙醇法监测灌流液吸收量,同时监测心率、平均动脉压,记录术中灌流液用量、手术时间和肾盂内压力,比较手术前后血红蛋白、血清Na＋、K＋、Cl-浓度、二氧化碳结合力及SCr值.结果 20例患者术中灌流液吸收量50.2～685.0（202.2±145.8）ml.手术前后心率、平均动脉压、Na＋、K＋、Cl和SCr值差异无统计学意义（P〉0.05）,术前血红蛋白浓度为（142.6±15.6）g/L,二氧化碳结合力（26.4±2.0）mmol/L,术后分别为（130.4士16.3）g/L、（24.1±3.2）mmol/L,手术前后比较差异有统计学意义（P〈0.05）.肾盂内压〉30 mm Hg（1 mm Hg=0.133 kPa）累计时间〉10 min,或手术时间〉1 h,或灌注液用量〉10000 ml者平均灌流液吸收量分别为381.1、301.6、261.6 m1,高于累计时间〈10 min,手术时间〈1 h,灌注液用量〈10000 ml者的142.9、136.4、130.2 ml,差异有统计学意义P〈0.05）.结论 乙醇法监测灌流液吸收量简便易行、安全有效,适用于心、肺、肾脏均功能差,易因灌流液吸收导致容量超负荷的PCNL病例.

Objective To explore the way to reduce the absorption of irrigating fluid during PCNL. Methods The amount of absorbed fluid during PCNL in 20 cases （13 males and 7 females）was monitored by ethanol method. The average age was 40 years old. The maximum diameter of calculi by average was 25 mm. Heart rate and mean arterial pressure were monitored during operation.Haemoglobin concentration, serum Na＋, K＋, Cl-, carbon dioxide-combining power and serum creatinine were measured before and after operation. The amount of irrigating fluid, the duration of operation, and the intrapelvic pressure were recorded. Results The absorbed volume of irrigating fluid in 20 cases was from 50. 2 to 685.0 ml. There was no significant difference in heart rate, mean arterial pressure, serum Na＋ , K＋ , Cl- and serum creatinine between pre-operation and post-operation（P〉0.05）, but the postoperative haemoglobin concentration （130.4±16.3 g/L） and carbon dioxide-combining power （24.1±3.2 mmol/L） were lower than that before operation（ 142.6±15.6 g/L,26.4±2.0 mmol/L）, the differences were significant （P〈0. 05）. The mean volume of absorbed irrigating fluid in patients with the cumutative time of the intrapelvic pressure higher than 30 mm Hg 〉10 min,the duration of operation 〉1 h, or the amount of irrigating fluid 〉10000 ml was 381. 1, 301.6,261.6 ml respectively, which was higher than that in the other cases （142.9, 136.4, 130.2 mi）, the differences were significant （P〈0.05）. Conclusions The ethanol method is simple, convinent,safe, valid, and is suitable for patients with compromised cardiorespiratory or renal function, who are more likely to develop volume overload because of fluid absorption.