软性输尿管镜碎石术中肾盂内压力监测方法及意义

Monitoring of renal pelvic pressure and its siginifcance during flexible ureteroscopic lithotripsy

目的 探讨软性输尿管镜碎石术中肾盂内压变化及其对术后并发症的影响.方法 总结2012年3月至2013年5月60例软性输尿管镜钬激光碎石术中肾盂内压变化及术后患者血清降钙素和内毒素数据,分析肾盂内压力变化与术后并发症之间的关系.肾盂内压力监测采用双腔（主通道和副通道）软性输尿管镜送达鞘,副通道内置4F输尿管导管连接测压系统,平均灌注流量30 ml/min,平均灌注压30 mmHg（1 mmHg=0.133 kPa）,每2 s采集一次数据,数据实时导入计算机并作统计学分析.以肾盂压力最高值（IPPmax）和IPPmax累计时间的不同,将患者分为正常压力组（IPPmax≤30 mmHg）、压力升高组（IPPmax ＞30 mmHg但累计时间≤10 min）、反流压力组（IPPmax ＞30 mmHg但累计时间＞ 10 min）共3组.结果 术中肾盂内压力初始值（IPP0）为（13.2±5.6） mmHg,IPPmax为（95.6±2.3） mmHg,差异有统计学意义（P=0.000）.60例中正常压力组32例,压力升高组17例,反流压力组11例.本组术后发热6例（10％）,其中正常压力组1例、压力升高组1例、反流压力组4例,各组术后发热发生率分别为3％、6％及36％,差异有统计学意义（P＜0.01）.60例中12例（20％）降钙素＞0.1 ng/ml,8例＞0.5 ng/ml,其中压力升高组2例和反流压力组6例.结论 软性输尿管镜钬激光碎石术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及灌注时间有关.患者术后发热风险与肾盂内压力及手术时间相关.应注意监控术中灌注压力.

Objective To monitor the renal pelvic pressure and to investigate its clinical significance during retrograde flexible ureteroscopic lithotripsy （RFUL）.Methods The data of renal pelvic pressure measured in 60 cases of RFUL with the mean irrigation pump speed and pressure of 30 ml/min and 30 mmHg were analyzed retrospectively.The influence factors of renal pelvic pressure and its correlation with postoperative fever were analyzed.Renal pelvic pressure was measured by baroceptor,which was connected to PHILIP-MP4 monitor IBP channel and ureteric catheter positioned in renal pelvis through a dual channel ureteral access sheath （UAS）.The renal pelvic pressure data was collected and analyzed in every 2 seconds by computer.The 60 cases were divided into 3 groups according to their intra-pelvic pressure situations：normal pressure group（NP,IPPmax ≤30 mmHg）,high pressure group（HP,IPPmax＞30 mmHg,but high pressure duration≤ 10 min）,and backflow pressure group（BP,IPPmax＞30 mmHg and high pressure duration＞ 10 min）.Results The baseline intra-pelvic pressure （IPP0） and max imum intra-pelvic pressure （IPPmax） were （13.2±5.6） mmHg and （95.6±2.3） mmHg respectively.IPP levels during the RFUL were significantly higher than the IPP0（P＜0.001）.There were 32,17 and 11 cases in NP,HP and BP groups,respectively.There were 6 cases with fever higher than 38.5 ℃ （10％）,in which there were 1 case in NP,1 case in HP group and 4 cases in BP group.The postoperative fever rate in NP,HP and BP group were 3％,6％ and 36％ respectively,which were significantly different between groups（P＜0.01）.There were 12 cases with procalcitonin ＞0.1 ng/ml and 8 cases with procalcitonin ＞0.5 ng/ml,in which 2 cases in HP group and 6 cases in BP group.Conclusions RFUL would result in a temporal elevated intrapelvic pressure greater than 30 mmHg.Postoperative fever is relevant with renal perfusion pressure and perfusion time.It＇s necessary for the surgeons to adjust the perfusion pressure during operation.