微通道经皮肾镜取石术中灌注液吸收对患者血液流变学的影响

Effects of Irrigation Fluid′s Absorption on Hemorheology during Mini-Percutaneous Nephrolithotomy

目的探讨微通道经皮肾镜取石术(mPCNL)中灌注液吸收对机体血液流变学指标的影响,为临床及时采取应对措施提供理论依据。方法选取我院2008年12月—2010年9月72例上尿路结石患者实施mPCNL,并分别检测灌注前(T1)、灌注60 min(T2)和灌注毕(T3)时的血液流变学指标水平。结果 72例患者手术均顺利完成。灌注液量为9.50～53.00 L,平均(22.74±9.87)L,未出现灌注液吸收综合征。T3、T2时的全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度、全血高切还原黏度、全血低切还原黏度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数和最大血小板聚集率与T1比较,差异均有统计学意义(P<0.05);T2时的血细胞比容与T1比较,差异有统计学意义(P<0.05);T3时的全血高切黏度、血浆黏度、血细胞比容、红细胞刚性指数、最大血小板聚集率与T2比较,差异均有统计学意义(P<0.05)。结论 mPCNL过程中存在一定量灌注液的吸收,手术时间过长、灌注液量较多时应加强对血液流变学指标的监测,并及时做出针对性处理。

Objective To explore the effects of irrigation fluid′s absorption on hemorheology during mini-percutaneous nephrolithotomy and to provide theoretical evidence for clinical treatment.Methods 72 patients with upper urinary tract stones from December 2008 to September 2010 were involved into the study.Normal saline was used as irrigation fluid during operation.Hemorheology was tested before irrigation（T1）,60 minutes during irrigating（T2） and after irrigation（T3）.Results All the operations were completed successfully without converting to open surgery or suspension because of bleeding.The irrigation fluid volume was 9.50~53.00 L and the mean volume was（22.74±9.87）L.No irrigation fluid absorption syndrome was found.There was significant decrease in whole blood viscosity at high,middle and low shear rate,plasma viscosity,the whole blood reduced viscosity at high and low shear rate,the index of RBC aggregation,the index of rigidity,the index of RBC deformation and the maximum rate of platelet aggregation at T3 and T2 compared with T1（P0.05）.HCT and the index of RBC rigidity showed statistically significant difference at T2 compared with T1（P0.05）.The whole blood viscosity at high shear rate,plasma viscosity,HCT,the index of RBC rigidity and the maximum rate of platelet aggregation showed statistically significant differences at T3 compared with T2（P0.05）.Conclusion Irrigation fluid′s absorption is involved in the process of mini-percutaneous nephrolithotomy.Hemorheology should be monitored when the operation time is extended and the irrigation fluid volume is large,and corresponding measures should be taken timely.