改良侧卧位经皮肾镜取石术对肾结石患者血流动力学的影响及其疗效分析

Effect of modified lateral decubitus percutaneous nephroscopy on hemodynamics of patients with renal calculi and its therapeutic effect

目的观察改良侧卧位经皮肾镜取石术(PCNL)对肾结石患者血流动力学的影响及其疗效。方法将108例PCNL患者分为俯卧位组52例和改良侧卧位组56例。检测两组患者在截石位、改变体位、改变体位30 min以及术毕4个时段的血压、心率及血氧饱和度;比较两组患者的手术疗效及并发症的发生率。结果在改变体位30 min及术毕时,两组患者的血压较截石位均下降(P<0.05),俯卧位组血压下降更为显著(P<0.05);且俯卧位组患者血氧饱和度在改变体位30 min及术毕时段较截石位下降且低于改良侧卧位组(P<0.05)。改良侧卧位组手术时间、碎石取石时间、血红蛋白下降水平及术后并发症发生率均低于俯卧位组(P<0.05);改良侧卧位组结石清除率高于俯卧位组(P<0.05)。结论改良侧卧位PCNL对肾结石患者血流动力学影响小,且具有结石清除率高,出血少及手术并发症低等优点。

Aim To observe the effect of modified lateral percutaneous nephrolithotomy(PCNL)on hemodynamics of patients with renal calculi and the efficacy of the operation.Methods 108 percutaneous nephroscopic patients were divided into modified prone position group(n=52)and lateral position group(n=56).Blood pressure,heart rate and blood oxygen saturation of the two groups were measured at lithotomy position,change of body position,change of body position for 30 min and after operation.The surgical efficacy and incidence of complications were compared between the two groups.Results After 30 minutes of postural change and at the end of surgery,the blood pressure decreased in both groups compared with the lithotomy position(P<0.05),especially in the prone position group(P<0.05).Blood oxygen saturation was lower in the prone position group than that in the modified lateral position group(P<0.05).The operation time,lithotripsy stone removal time,hemoglobin decreased level and postoperative complication rate in modified lateral decubitus group were lower than those in prone position group(P<0.05).The calculi clearance rate in modified lateral decubitus group was higher than that in prone position group(P<0.05).Conclusion Modified lateral decubeus percutaneous nephroscopy has little effect on the hemodynamics of patients with kidney stones,increases the patient’s tolerance to surgery,and has the advantages of high calculus clearance rate,less bleeding and low surgical complications.