经皮肾镜取石术不同灌注时间对氧合指数及酸碱平衡的影响

Impact of different irrigation time on oxygenation index and acid-base balance during percutaneous nephrolithotomy

目的观察经皮肾镜取石手术(PCNL)在不同灌注时间下灌洗液吸收对患者氧合指数及酸碱平衡的影响。方法择期全身麻醉下行PCNL患者40例,按照灌注时间分为两组:S组,灌注时间<120min(n=22);L组,灌注时间≥120min(n=18)。麻醉诱导后监测CVP,灌注中每20分钟监测一次并记录灌注中最高值,术中检测灌注前后动脉血气分析并记录氧合指数、pH及BE值。结果两组患者灌注中CVP最高值L组明显高于S组(P<0.05),灌注后L组氧合指数明显低于灌注前(P<0.05),灌注前后L组氧合指数差值明显大于S组(P<0.05)。灌注后L组pH及BE值均明显低于S组(P<0.05)。结论 PCNL长时间灌注有导致肺氧合功能下降,代谢性酸中毒的风险,术中应适当缩短灌注时间。

Objective To investigate the impact of different irrigation time on oxygenation in-dex and acid-base balance during percutaneous nephrolithotomy（PCNL）.Methods Forty patients un-dergoing selective PCNL were included in this study,were divided into two groups：group S,irrigation time〈120 min（n=22）;group L,irrigation time≥120 min（n=18）.PaO2/FiO2 ,pH and BE were determined before and after irrigation,CVP were recorded before irrigation and every 20 min during irrigation. Results The CVP maximum value were higher in group L than that in group S during irrigation （P 〈0.05）.The PaO2/FiO2 were lower after irrigation than that before irrigation in group L（P〈0.05）.The pH and BE were lower in group L than that in group S after irrigation（P〈0.05）.Conclusion Irrigation fluid absorption is observed during PCNL.That can provoke oxygenation function decline and metabolic ac-idosis with irrigation time extend,the operation time properly shortened.