微通道与标准通道经皮肾镜碎石术对肾结石患者血流动力学和血气分析的影响

Effects of micro channel and standard channel percutaneous lithotripsy on hemodynamics and blood gas anal-ysis in patients with renal calculi

目的：探究微通道（mPCNL）与标准通道经皮肾镜碎石术（sPCNL）对肾结石患者血流动力学和血气分析的影响。方法选取2007年3月至2015年6月收治的180例肾结石患者作为研究的对象，通过数字表法将患者随机分为 mPCNL 组和 sPCNL 组，前者通过 F16塑料建立经皮肾通道，后者通过 F24塑料建立经皮肾通道。观察并比较两组围术期的血流动力学指标变化及血气分析。结果 mPCNL 组的手术时间显著短于 sPCNL 组（t ＝－6．018，P ＜0．05），灌流液量高于 sPCNL 组（t ＝20．506，P ＜0．05）；两组灌流前平均动脉压（MAP）、中心静脉压（CVP）均显著低于麻醉前，且灌流后不同时段及术后均显著高于灌流前，60 min、120 min、术后 mPCNL 组患者 MAP 值，检验值依次为（t60min ＝5．878，t120min ＝6．802、t术后＝7．070）；60 min、120 min、术后 mPCNL 组患者 CVP 值，检验值依次为（t60min ＝5．987，t120min ＝6．505、t术后＝7．180）（P ＜0．05）。60 min、120 min、术后 sPCNL 组患者 MAP 值，检验值依次为（t60min ＝5．613，t120min ＝7．238、t术后＝7．170）；60 min、120 min、术后 sPCNL 组患者 CVP 值，检验值依次为（t60min ＝7．682，t120min ＝7．135、t术后＝9．218）；血气分析显示，两组术后 Na ＋、Cl －与麻醉前比较，差异无统计学意义（P ＞0．05）。两组术后 K ＋、pH、BE、Hb 均低于麻醉前，差异有统计学意义（P ＜0．05）；两组患者术后均无尿脓毒症及其他严重并发症发生。结论随着手术时间增加，灌流液的吸收对血流动力学和动脉血气分析的影响逐渐增加；对于心、肺、肾功能正常的患者，由于器官功能的代偿，mPCNL 与 sPCNL 引起的灌流液吸收量的差异不足以引起患者血流动力学和血气分析的不同。

Objective To explore the effects of micro channel （mPCNL）and standard channel percutaneous lithotripsy （sPCNL）on hemodynamics and blood gas analysis in patients with renal calculi.Methods From March 2007 to June 2015,180 patients with kidney stones were selected as the research subjects,through digital said method,the patients were randomly divided into MPCNL group and sPCNL group,the former F16 plastics through established channels of percutaneous nephrolithotomy.The latter F24 plastics through established channels of percuta-neous nephrolithotomy.The changes of hemodynamics and blood gas analysis were observed and compared in the two groups during perioperative period .Results In MPCNL group ,theoperation time was significantly shorter in sPCNL group（t =-6.018）,the perfusion fluid was higher than that of sPCNL group（t =20.506,P 〈0.05）.The perfusion of MAP and CVP of the two groups were significantly lower than those before anesthesia,and irrigation flow after dif-ferent time and postoperative were significantly higher than those before hemoperfusion,60 min,120min,after opera-tion MAP value of MPCNL group,test value was as follows（t60min =5.878,t120min =6.802,tpostoperative =7.070,all P 〈0.05）;60min,120min,after operation CVP value of MPCNL group,test value was as follows （t60min =5.987,t120min =6.505,tpostoperative =7.180,all P 〈0.05）.60min,120min,postoperative MAP value of sPCNL group,test value was as follows （t60min =5.613,t120min =7.238,tpostoperative =7.170,all P 〈0.05）;60min,120min,postoperative the CVP value of sPCNL group,test value was as follows （t60min =7.682,t120min =7.135,t[postoperative]=9.218,all P 〈0.05）. Blood gas analysis showed that the two groups of postoperative Na ＋,Cl - compared with before anesthesia had no sta-tistically significant difference（P 〉0.05）.Two groups of postoperative K ＋,pH,BE,Hb were lower than before anes-thesia,the differences were statistically significant （P 〈0.05）.The two groups of patients with no postoperative urina-ry sepsis and other serious complications.Conclusion With the increase of operation time filling fluid absorption on hemodynamics and arterial blood gas analysis of influence gradually increased;in heart,lung and normal renal function patients,due to the compensatory organ function,caused by MPCNL and sPCNL irrigation fluid absorption differences in the amount is not enough to cause different hemodynamics and blood gas analysis.