输尿管软镜碎石术中肾盂内压力监测

Monitoring of renal pelvic pressure during flexible ureteroscopic Lithotripsy

目的 建立输尿管软镜碎石术中肾盂压力监测的合理方法,获得输尿管软镜术中肾盂压力的变化;了解术后感染与肾盂内压力的关系.方法 对35例行输尿管软镜碎石患者根据不同灌注压力在手术中持续的时间,分为A（灌注压力＜ 50mmHg）、B（50mmHg＜灌注压力＜100mmHg）、C（灌注压力＞100mmHg）三组,通过压力换能器实时监测不同灌注压力下肾盂压力变化,了解灌注压与肾盂压力的关系.分析肾盂内压力与术后感染的相关性.结果 （1）术中肾盂内压力初始值IPP0为（13.2 ＋3.1） mmHg,A组肾盂内压力最高值IPPmaxA为（38.3±4.3）mmHg;B组肾盂内压力最高值IPPmaxB为（64.3±5.5）mmHg;C组肾盂内压力最高值IPPmaxC为（95.6 ±2.3）mmHg,各组与IPP0比较,差异呈显著性（P＜0.01）.（2）术后高热6例,占总数的百分比为17.14％,A组10.00％;B组16.67％;C组23.07％.各组之间比较,差异性显著（P＜0.01）.结论 输尿管软镜钬激光碎石中存在肾盂内高压现象,术中肾盂内压力变化与灌注压力大小有关.患者术后感染风险与术中肾盂内持续高压相关.

Objectives To investigate the changes of renal pelvic pressure in response to continuous irrigation at different pressures during flexible ureteroscopic lithotripsy,Learn the relationship between postoperative infection and renal pelvic pressure.Methods According to the perfusion pressure and continuous perfusion time,35 patients with flexible ureteroscopic lithltripsy were divided into A,B,C,three groups.Montitoring renal pelvic pressure by pressure transducer with different prefusion pressure,learn the relationship between them.Analysis the correcation between internal pressure and postoperative infections of the renal pelvic.Results （1） The average IPPO was （13.2 ± 3.1） mmHg,the maximum intra-pelvic pressure of three groups A （IPPmaxA） （38.3.2 ± 3.1） mmHg,B （IPPmaxB） （64.3 ± 5.5） mmHg,C （IPPmaxC） （95.6 ± 2.3） mmHg.The IPP levels during three groups （A,B,C） were all significantly higher than the IPP0（P ＜0.01）.（2） six patients were high fever,of the total percentage was 17.14％,group A was 17.14％,group B was 16.67％,group C was 23.07％.Comparison between groups,the diversity was significantly（P ＜ 0.01）.Conclusions The renal pelvic pressure is significantly increased during flexible ureteroscopic lithotripsy.The renal pelvis pressure associated with perfusion pressure and continuous perfusion time.Patients with postoperative infection risk associated with the high pressure in the renal pelvis.