无管化经皮肾镜取石术与标准经皮肾镜取石术的效果及护理

A comparative nursing study of tubeless and standard percutaneous nephrolithotomy

目的探讨无管化经皮肾镜取石术（tubeless-PCNL）与标准经皮肾镜取石术（standard-PCNL）治疗肾结石的疗效和护理方法。方法回顾性分析35例标准经皮肾镜治疗组和12例无管化经皮肾镜治疗组患者资料，对两组患者手术时间、术中出血、术后疼痛评分和镇痛药物使用、术后住院时间和恢复情况等方面进行比较。结果两组患者术后恢复顺利，术后24h标准PCNL组视觉模拟评分（VAS）结果为（5．9±0．51）分，无管化PCNL组为（3．1±0．48）分，差异有统计学意义（t=2．72，P〈0．01）；标准治疗组术后镇痛药物哌替啶使用剂量为（126．5±33．3）mg，无管化治疗组为（81．7±24．5）mg，组间比较差异具有统计学意义（t=3．31，P〈0．01）。结论无管化PCNL减少术后疼痛和尿外渗发生，与标准经皮肾镜治疗比较缩短住院时间，减轻了患者的痛苦，提高了护理工作效率。

Objective To compare the pest operative nursing between tubeless and standard percutaneous nephrolithotomy. Methods The retrospective study was done on both 35 cases with standard percutaneous nephrolithotomy and 12 cases with tubeless percutaneous nephrolithotomy. The following variables were statistically analyzed： the operation time, postoperative pain, analgesia requirement, blood loss, postoperative morbidity and postoperative hospital stay, etc. Results All patients had an uneventful postoperative recovery. The average visual analogue scale pain score on postoperative day 1 for the standard PCNL group patients was （5.9 ± 0. 51 ） compared with （ 3.1± 0.48 ） in the tubeless group （ t = 2. 72, P 〈 0. 01 ）. The mean analgesia requirement for the standard PCNL group （meperidine 126.5 ± 33.3 mg） was significantly more than the tubeless group （meperidine 81.7 ± 24.5 mg） （t = 3. 31, P 〈 0. 01 ）. Conclusions Tubeless PCNL reduces postoperative urinary leakage and local pain related to the drainage tube. It also minimizes hospital stay; the majority of patients were discharged from the hospital in less than 24 hour. With the hypothesis of same therapy effect, it may reduce the pains of patients and the difficulty of nursing, which may improve the working efficiency of medical treatment and nursing.