前列地尔治疗后腹腔镜肾部分切除术后早期少尿临床疗效分析

Clinical effect of alprostadil in the treatment of early oliguria after retroperitoneal laparoscopic partial nephrectomy

目的探讨前列地尔治疗后腹腔镜肾部分切除术后早期少尿的临床疗效。方法选取2016年1月至2019年1月于瑞安市人民医院行后腹腔镜肾部分切除术后早期少尿患者72例,采用抽签法将患者分为A组(n=35)和B组(n=37)。A组患者给予常规治疗联合前列地尔注射液治疗,B组患者给予常规治疗。比较两组患者连续治疗7d的尿量、血肌酐(serum creatinine,Scr)和血尿素氮(blood urea nitrogen,BUN)水平,治疗前、治疗3d的内生肌酐清除率(creatinine clearance rate,Ccr)和β2微球蛋白(β2-microglobulin,β2M)及疗效和不良反应发生率。结果治疗1d、2d、3d、4d,A组患者的24h尿量均显著高于B组,BUN水平均显著低于B组(P<0.05);治疗5d、6d、7d,两组患者的24h尿量、BUN水平比较差异均无统计学意义(P>0.05)。治疗1d、2d、3d,A组患者的Scr水平均显著低于B组患者(P<0.05);治疗4d、5d、6d、7d,两组患者的Scr水平比较差异均无统计学意义(P>0.05)。治疗3d,两组患者的Ccr水平显著高于本组治疗前,β2M水平显著低于本组治疗前(P<0.05);A组患者的Ccr水平显著高于B组,β2M水平显著低于B组(P<0.05)。A组患者的治疗总有效率显著高于B组(97.14%vs.72.97%,P<0.05)。两组患者治疗期间腹泻、血压异常、皮疹及瘙痒发生率比较差异均无统计学意义(P>0.05)。术后1个月、6个月、12个月,两组患者的Scr、BUN水平均在正常范围内,两组比较差异均无统计学意义(P>0.05)。结论前列地尔注射液用于肾部分切除术后患者早期少尿的辅助治疗,可早期改善患者的肾脏功能、增加尿量,协助提高疗效、改善预后。

Objective To investigate the clinical effect of alprostadil in the treatment of early oliguria after retroperitoneal laparoscopic partial nephrectomy.Methods A total of 72 patients with early oliguria after laparoscopic partial nephrectomy in Ruian City People’s Hospital from January 2016 to January 2019 were selected and divided into group A(n=35)and Group B(n=37)by lottery method.Patients in group A were given conventional treatment combined with alprostadil injection,and patients in group B were given conventional treatment.Urine volume,serum creatinine(Scr)and blood urea nitrogen(BUN)after continuous treatment for 7 days,the creatinine clearance rate(Ccr)and β2-microglobulin(β2M)before treatment and after 3 days of treatment,efficacy and incidence of adverse reactions were compared between the two groups.Results After treatment for 1 day,2 days,3 days,and 4 days,24h urine volume in group A were significantly higher than that in group B,and BUN level was significantly lower than that in group B(P<0.05);after treatment for 5 days,6 days,and 7 days,there was no significant difference in 24h urine volume and BUN level between the two groups(P>0.05).After treatment for 1 day,2 days and 3 days,the Scr level of group A were significantly lower than that of group B(P<0.05),after treatment for 4 days,5 days,6 days and 7 days,there was no significant difference in the level of Scr between the two groups(P>0.05).After 3 days of treatment,the Ccr level in two groups was significantly higher than before treatment,and the β2M level was significantly lower than before treatment(P<0.05);Ccr level of group A was significantly higher than that of group B,and β2M level was significantly lower than that of group B(P<0.05).The total effective rate of group A was significantly higher than that of group B(97.14%vs.72.97%,P<0.05).There were no significant differences in the incidence of diarrhea,abnormal blood pressure,rash and pruritus between the two groups during treatment(P>0.05).Postoperative 1 month,6 months,12 months,the Scr and BUN levels of the two groups of patients were within the normal range,and there was no statistical significance between the two groups(P>0.05).Conclusion Alprodill injection is used in the adjuvant treatment of early oliguria in patients after partial nephrectomy,which can improve the kidney function,increase urine volume,assist to improve the curative effect and prognosis.