【摘要】 目的:比较分析输尿管软镜碎石术(URL)、微创经皮肾镜取石术(MPCNL)、体外冲击波碎石术(ESWL)治疗对上尿路结石患者血流动力学及血气指标的影响。方法:选取2013年8月至2015年10月四川省自贡市第四人民医院收治的300例肾结石患者为研究对象,按照随机数字表法分为URL组、MPCNL组及ESWL组,每组各100例。记录并比较3组患者的手术时间、手术成功率、住院时间及术后发热情况;麻醉前、灌流前、灌流1h及术后的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP);麻醉前、灌流前、术后的Na+、Cl-、K+、pH值及碱剩余(BE)。结果:ESWL组手术时间显著低于URL组(P<0.05),手术时间及住院时间显著低于MPCNL组,而手术成功率也显著低于其他两组(P<0.05);MPCNL组的手术时间及住院时间均显著低于URL组(P<0.05)。3组患者组间的各项血流动力学指标和血气分析指标比较,差异均无统计学意义(均P>0.05),3组患者在不同时间点的HR、Na+和Cl-比较差异无统计学意义(P>0.05),而灌流前MAP、CVP以及K+、pH值、BE水平均低于麻醉前,差异有统计学意义(P<0.05)。此外,ESWL组的术后发热率显著低于URL和MPCNL组(P<0.05)。结论:URL、MPCNL及ESWL均能有效地清除上尿路结石,3者手术时间递减,但对于肾、心、肺功能正常的患者,其血气分析与血流动力学并无明显差异。更多还原

【Abstract】 Objective:To investigate the effects of ureteroscopic lithotripsy(URL),minimally invasive percutaneous nephrolithotomy(MPCNL)and extracorporeal shock wave lithotripsy(ESWL)on hemodynamics and blood gas indexes in patients with upper urinary tract calculi.Methods:300patients with upper urinary tract calculi in our hospital from August 2013 to October 2015 were recruited and divided into the URL,MPCNL and ESWL groups(100cases in each group).The duration of operation,the success rate of surgery,duration of hospitalization and the postoperative body temperature were recorded and compared among groups.Heart rate(HR),mean arterial pressure(MAP)and central venous pressure(CVP)as well as blood gas indexes including the electrolyte levels(Na+,Cl-,K+),pH value and base excess(BE)were determined at pre-anesthesia,pre-perfusion,1hpostperfusion and postoperation.Results:The duration of operation and the success rate of surgery in ESWL group were significantly lower than those in URL group and MPCNL group(P <0.05).The duration of hospitalization was significantly lower than that in MPCNL group(P <0.05).The duration of operation and hospitalization in MPCNL group were significantly lower than those in the URL group(P <0.05).There was no significant difference among three groups in the hemodynamic parameters and blood gas indexes(P >0.05).There was also no significant difference in the HR,Na+and Cl-levels at different time points among groups(P >0.05),but the MAP,CVP,K+level,pH value and BE at pre-perfusion were markedly lower than those at pre-anesthesia(P >0.05).Moreover,the postoperative fever rate of ES-WL group was significantly lower than that of URL group and MPCNL group(P <0.05).Conclusion:URL,MPCNL and ESWL can effectively remove the upper urinary tract calculi,and URL shows the shortest operation time.There was no significant difference in blood gas indexes and hemodynamics in patients with normal kidney,heart and lung function.更多还原