局麻微创经皮肾镜对全身炎症反应及肾功能损害的影响

Influence of minimally invasive percutaneous nephroscope with local anesthesia on systemic inflammatory response and renal function damage

目的通过对局麻微创经皮肾镜治疗肾结石及输尿管上段结石导致的全身炎症反应、肾功能损害等临床资料进行分析,评估局麻微创经皮肾镜的安全性、有效性、可行性、经济效益及其临床推广应用价值。方法东莞市大朗医院泌尿外科在2012年8月至2014年8月将经皮肾镜患者随机分成观察组及对照组(各40例),观察组行局麻,对照组行腰硬联合麻醉。对比两组术前晨、手术结束时及术后一周血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、β2-微球蛋白(β2-MG)、C-反应蛋白(CRP)、肌酐(Cr)及尿素氮(BUN)的表达水平;同时对比两种麻醉状态对患者心率(HR)、血氧饱和度(SPO2)及平均动脉压(MAP)的影响;并比较两组间手术时间、术中出血量、住院时间、住院费用及残石率的差异。结果两组患者术前晨血BUN、Cr、β2-MG、IL-6、TNF-α及CRP组间比较差异无统计学意义(P>0.05),两组各项参考指标在手术结束时明显高于术前。对照组术后一周血清IL-6、TNF-α、CRP含量高于观察组,两组术后一周血清BUN、Cr、β2-MG低于术前,差异有统计学意义(P<0.05)。观察组及对照组MAP、HR、SPO2在手术开始前、手术中与麻醉前比较差异有统计学意义(P<0.05)。两组间手术时间、术中出血量及残石率比较无统计学差别(P>0.05),观察组住院时间及住院费用明显低于对照组,差异有统计学意义(P<0.05)。结论局麻微创经皮肾镜治疗肾结石及输尿管上段结石引起的全身炎症反应较轻,总费用及住院时间明显低于腰硬联合麻醉组,两组患者肾功能损伤差别无统计学意义。

Objective To investigate clinical data of 80 cases with upper urethral stones and kidney stones under minimally invasive percutaneous nephroscope, and assess the safety, efficacy, feasibility, economic and clinical application value of local anesthesia for this surgery. Methods 80 cases were randomly divided into observation group and control group （40 cases each group）. The observation group underwent minimally invasive percutaneous telephotography lithography with local anesthesia, while the control group underwent epidural anesthesia. The expressions of IL-6, TNF-α, β2-MG, CRP, Cr and BUN were detected in preoperative morning, postoperative and one week after operation. HR, SPO2, MAP, operation time, intraoperative blood loss, average length of hospital stay and hospital costs, residual stone rate were compared between the two groups. Results BUN, Cr, β2-MG, IL-6, TNF-α and CRP were not statistically significant different between the two groups in preoperative morning （P〉0.05）, but the postoperative expressions were significantly higher than preoperative. One week after surgery, IL-6, TNF-αand CRP of observation group slightly higher than control group. BUN, Cr, β2-MG were lower in one week after surgery than preoperative in both groups （P〈0.05）. MAP, HR, SPO2 were statistically significant difference in preoperative, intraoperative and before anesthesia （P〈0.05）. Operation time and blood loss was not statistically observation significant difference （P〉0.05）between the two groups. The average length of stay and hospital costs in group were significantly lower than the control group（P〈0.05）. Conclusion Minimally invasive percutaneous telephotography under local anesthesia for kidney stones and upper urethral calculi is worthy of clinical application, because of less systemic inflammatory response, lower total cost and shorter length of hospital stay.