输尿管软镜术肾盂内压的测定与术后发热的关系

Correlation of monitoring the renal pelvic pressure in RIRS and the morbidity of postoperative fever

目的探讨输尿管软镜钬激光碎石术中动态监测肾盂压变化及手工冲洗法调整灌注压力的临床意义。方法回顾性分析2014年8月至2017年8月在本院接受输尿管软镜下钬激光碎石术治疗的189例上尿路结石患者的临床资料,其中术中动态监测肾盂内压患者136例(监测组),未监测患者53例(未监测组);监测组患者依据肾盂内压力(IPP)又分为高压组49例(术中IPP≥40 cm H2O且累计时间超过1 min)及低压组87例。统计监测组及未监测组、高压组及低压组患者术后3 d的发热率(T≥38.5℃)。结果术后发热与患者年龄、性别、患肾、术前尿路感染、结石部位无明显关系,而与是否监测肾内压、感染性结石、手术时间、术中肾盂内压肾盂压力大于等于40 cm H2O且累计时间超过1 min相关。未监测组术后发热率高于监测组,高压组术后发热率高于低压组,差异均有统计学意义(P<0.05)。结论输尿管软镜术术中动态监测肾盂压变化,手工灌注控制肾盂内压力对患者术后恢复有积极意义,有助于减少术后发热。

Objective To investigate the clinical significance of monitoring the renal pelvic pressure（ RPP） and regulating the manual perfusion pressure in flexible ureteroscope holmium laser lithotripsy. Methods A total of 189 patients with upper urinary tract calculi treated by RIRS in our hospital were retrospectively analyzed from August 2014 to August 2017. The renal pelvic pressure was monitored during RIRS in 136 cases（ monitored group） whereas no monitoring occurred in the rest 53 cases（ unmonitored group）. The monitored group was divided into two sub-groups of 49 cases named high-pressure group（ the cumulative time of renal pelvis pressure upon 40 cm H2 O≥1 min） and 87 cases named low-pressure group respectively. The morbidity of postoperative fever（ T≥38. 5℃） was evaluated statistically between monitored group and unmonitored group,meanwhile between high-pressure group and low-pressure group. Results Postoperative fever did not correlate to age,sex,involved kidney,and postoperative urinary tract infection. Whether renal pelvic pressure was monitored or not,infection calculi,duration of operation and whether the cumulative time of renal pelvis pressure upon 40 cm H2 O≥1 min contributed to postoperative fever. The rate of postoperative fever in unmonitored group was higher than monitored group while the same between high-pressure group and low-pressure group,with statistically significant difference（ P〈0. 05）. Conclusion Monitoring the intraoperative RRP and regulating the manual perfusion pressure during RIRS has positive significance in postoperative recovery and contribute to reducing postoperative fever.