经皮肾镜取石术中血流动力学及生化指标变化

The changes of hemodynamics and blood biochemistry during percutaneous nephrolithotomy

目的:探讨经皮微造瘘肾镜取石术(mPCNL)中灌注液吸收对机体血流动力学、血生化指标的影响。方法:选择上尿路结石患者79例,实施经皮微造瘘肾镜取石术,术中监测灌注前、灌注后30 min、60 min、90 min及120 min时心率(HR)、收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)、氧饱和度(SpO2)、红细胞压积(HCT)、血电解质、血肌酐(Scr)、胱抑素C(Cys C)、酸碱度(pH)、碱剩余(BE)。结果:灌注液用量(19 491±5 865)ml,速度(174.46±58.28)ml/min,出入差(1 086.44±415.20)ml。灌注60 min时,Cys C升高,差异具有统计学意义(P<0.05)。灌注90 min时,HR、CVP、Cl-逐渐升高,SBP、HCT、pH及BE逐渐下降,差异具有统计学意义(P<0.05)。灌注120 min时,HR、SBP、CVP、HCT、Cl-的变化差异具有统计学意义(P<0.01)。Scr逐渐升高,差异具有统计学意义(P<0.05);手术前后Na+,K+较差异无统计学意义(P>0.05)。结论:长时间的mPCNL引起血液动力学、血生化和胱抑素C的变化,应严密监测,适当降低灌注压力、速度,缩短手术时间。

Objective： To explore the effects of irrigation fluid absorption on hemodynamic,electrolyte balance and blood biochemistry during mini-percutaneous nephrolithotomy（mPCNL）. Methods： Seventy-nine patients with upper urinary calculi were involved in this study.Heart rate（HR）,systolic blood pressure（SBP）,diastolic pressure（DBP）,central venous pressure（CVP）,blood O_2 saturation（SpO_2）,Hematocrit（HCT）,Serum Na＋,K＋,Cl-,Scr,Cystatin C,pH and base excess（BE） were detected before and after operation every 30 min during irrigation. Results： The mean irrigation fluid volume was（19 491±5 865）ml,and mean irrigation velocity was（174.46±58.28）ml/min,the changes of intake and output was（1 086.44±415.20）ml.Cystatin C was increased significantly higher than those of preoperation at 60min after irrigation（P0.05）.HR,CVP,Cl-were increased significantly higher（P0.05） while SBP、HCT、pH and BE were decreased significantly lower than those of preoperation at 90 min（P0.05）.At 120min after irrigation,HR,CVP,Cystatin C were increased significantly higher than those of preoperation（P0.01） while SBP,BE were decreased significantly lower than those of preoperation（P0.01）.Scr was gradually increased and have significant difference（P0.05）,but there was no significant difference in Na＋,K＋ changes during and after irrigation（P0.05）. Conclusion： Changes of hemodynamic,electrolyte balance,blood biochemistry and Cystatin C during mPCNL may be caused by long time absorption of irrigation fluid.To reduce the velocity and pressure of irrigation fluid,shorten the operation time,and keep close monitoring of hemodynamic,electrolyte balance,blood biochemistry was very important.