输尿管镜下钬激光治疗上尿路结石的临床疗效以及对血流动力学和血气指标的影响分析

Effect of Ureteroscopic Holmium Laser on Upper Urinary Tract Calculi and its Influence on Hemodynamics and Blood Gas Indexes

目的探讨输尿管镜钬激光在上尿路结石中的临床效果以及对血流动力学、血气指标的影响。方法选择2015年3月~2017年7月科室收治的上尿路结石患者64例,随机数字法分为对照组(n=32例)和观察组(n=32例)。对照组采用经皮肾镜超声气压弹道碎石术治疗,观察组采用输尿管镜钬激光治疗;采用普生血流测试仪测定2组治疗前、后血浆黏度、全血低切黏度、全血中切黏度、全血高切黏度、红细胞压积等血液流变学水平;采用血气分析仪测定2组治疗前后Na^+、CL^-、K^+、PH及碱剩余(BE)水平,比较2组临床疗效及对血流动力学、血气指标的影响。结果观察组手术后血浆黏度、全血低切黏度、全血中切黏度、全血高切黏度、红细胞压积等血液流变学水平,均低于对照组(P<0.05);2组手术前BE及K+水平无统计学意义(P>0.05);观察组手术后BE及K^+水平,均低于对照组(P<0.05);观察组术后结石清除率,高于对照组(P<0.05);观察组术后并发症、复发率,均低于对照组(P<0.05)。结论输尿管镜下钬激光用于上尿路结石患者中有助于改善血流动力学、血气指标水平,降低术后并发症发生率,值得推广应用。

Objective To investigate the clinical effect of ureteroscopic holmium laser in upper urinary calculi and its effect on hemodynamics and blood gas indexes.Methods 64 patients with upper urinary calculi admitted to the department from March 2015 to July 2017 were selected,and randomly divided into control group(n=32)and observation group(n=32).The control group was treated with percutaneous nephrolithotripsy and the observation group was treated with ureteroscopy holmium laser.Plasma viscosity,whole blood low cutting viscosity,whole blood medium cutting viscosity,whole blood high cutting viscosity,hematocrit and other hemorheological levels were measured before and after treatment in the two groups by using a prussin blood flow tester.Blood gas analyzer was used to determine Na+,CL-,K+,PH and alkali residue(BE)levels before and after treatment in the two groups,and the effects of the two groups on hemodynamics and blood gas indexes were compared.Results The hemorheological levels of plasma viscosity,whole blood low cutting viscosity,whole blood medium cutting viscosity,whole blood high cutting viscosity and hematocrit were all lower in the observation group than in the control group(P<0.05).There was no significant difference in the levels of BE and K+before surgery in the 2 groups(P>0.05).The levels of BE and K+in the observation group were lower than those in the control group(P<0.05).The postoperative calculi clearance rate of the observation group was higher than that of the control group(P<0.05).The rate of postoperative complications and recurrence in the observation group was lower than that in the control group(P<0.05).Conclusion Ureteroscopic holmium laser can improve hemodynamics,blood gas level and reduce the incidence of postoperative complications in patients with upper urinary calculi.