微创经皮肾镜取石术对肾血流动力学和血气分析的影响

Effect of minimally invasive percutaneous nephrolithotomy lithotomy on renal hemodynamics and blood gas analysis

目的探讨经皮肾镜碎石术(MPCNL)中"腰肋悬空"仰卧位对老年患者肾血流动力学和血气分析的影响。方法择期行经皮肾镜碎石术的老年患者45例。监测时点为术前(T0)、麻醉后"腰肋悬空"仰卧位10 min(T1)、手术30 min(T2)、60min(T3)以及术毕(T4)。监测项目为血压(BP)、心率(HR)、脉搏氧饱和度(SpO2),T0、T3、T4时动脉血气分析测血酸碱度(pH)、Na+、K+、阴离子间隙(BE)、红细胞压积(Hct);记录手术情况。结果摆放体位后10 min患者舒张压(DBP)、收缩压(SBP)和HR略有下降。随着手术时间的延长,BP和HR逐渐恢复至基础水平值。SpO2值在手术过程中逐渐降低,至T3时最低。结论经皮肾镜碎石术中腰肋悬空仰卧位对老年患者血流动力学和内环境的影响较小。手术过程应进行严密的监测和预防处理,并适当缩短手术时间。

Objective To investigate the influence of renal hemodynamies and blood gas analysis in elderly patients with pereutaneous renal mirror lithotripsy （MPCNL） in supine position with hanging lumbus and ribs. Methods Forty - five elderly patients were given percutaneous nephrolithotripsy in selective dates. Monitoring points included pre-operation （T0）, 10 min （T1） after supine position with hanging lumbus and ribs after anesthesia, 30 min （T2） and 60 min （T3） after operation as well as the completion of surgery （T4）. Blood pressure （BP）, heart rate （HR）, pulse oxygen saturation degree （SpO2） were detected, blood pH （pH）, Na＋, K＋, anion gap （BE）, hematocrit （Her） at To, T3 and T4 were examined by arterial blood gas analysis and surgical condition was recorded. Results Diastolic blood pressure （DBP）, systolic blood pressure （SBP） and FIR decreased slightly 10 min after patients were placed in supine position. BP and HR gradually re- covered as usual with the extension of operative duration. During the operation, SpO2 value gradual- ly decreased and reached its lowest level at T3. Conclusion The flank suspended supine position has less impact on hemodynamics and internal environment of the elderly patients with percutaneous nephrolithotripsy. Therefore, the hemodynamics change and blood gas analysis should be strictly in- spected and the operative duration should be properly shortened.