输尿管镜碎石术中肾盂内压力变化对术后发热的影响

Characters and significance of renal pelvic pressure in minimally invasive ureteroscopic lithotripsy for urethral calculis

目的:探讨输尿管镜碎石术术中肾盂压力的变化对术后发热的影响。方法:采用压力传感器实时测量124例行输尿管镜碎石术的患者肾盂内压力,分析肾盂内压力的变化与术后发热的关系。结果:124例患者术中平均肾盂内压2.07kPa(1kPa=7.5mm Hg),肾盂内压力≥4.00kPa平均累计时间为96.72s。术后有30例(24.2%)患者发热。术后发热与患者年龄(P=0.243)、性别(P=0.135)、尿路感染(P=0.183)、术后血常规白细胞≥10×109/L(P=0.317)、术中肾盂内压力曾经≥5.33kPa(P=0.260)无明显关系。而与感染性结石(P=0.002)、术中平均肾盂内压力≥2.67kPa(P=0.017)、肾盂内压力≥4.00kPa持续时间(P=0.011)相关。结论:术后发热与输尿管镜碎石术导致的肾盂内压力短暂性增高不相关,但术中平均肾盂内压力、肾盂内压力≥4.00kPa持续时间升高将引起术后发热率增高。

Objective： To investigate the renal pelvic pressure （RPP） during minimally invasive ureteroscopic lithotripsy for urethral calculi, and inspect its influence to postoperative fever. Method：The RPP was measured by barometer. And these data about pressure and postoperative fever were evaluated statically. Result：The mean RPP was 2.07 kPa, the mean accumulative time of RPP≥4.00 kPa was .96.72 s. 30 cases （24.2%） had a postopera- tive fever. Logistic analysis suggested that postoperative fever did not correlate to age（P=0. 243）, sex（P=0. 135）, urinary tract infection （P=0. 183）, white blood cell ≥10× 10^9/L in blood routine examination postoper atively （P=0.317）, once an occurrence of RPP ≥5. 33 kPa （P= 0. 260）, while infection calculi（P 0.002）, mean RPP ≥2.67 kPa （P=0. 017）, and RPP ≥4.00 kPa longer than 60s（P=0. 011） contributed to postopera- tive fever. Conclusion：A transient RPP ≥30 mm Hg don＇t contribute to postoperative fever, while a temporary high pressure（60s） would had an accumulated effect which means an enough back flow to bring a fever.