目的 探讨肾盂内压力(intra pelvic pressure,IPP)在超微通道经皮肾镜碎石术中的应用研究.方法 选取 2022 年1 月至 2023 年 1 月嘉兴市第一医院收治的 60 例需进行超微通道经皮肾镜碎石术(super mini-PCNL,SMP)术的泌尿系结石患者作为研究对象.采用随机数字方法分为对照组及试验组,每组 30 例.两组患者均采用超微通道经皮肾镜碎石术进行治疗,而试验组在术中实时监测及调控IPP,观察并对比两组患者临床相关指标、IPP、发热、尿蛋白、肾功能、血红蛋白(hemoglobin,Hb)及不良反应.结果 与对照组比较,试验组患者住院时间缩短,结石清除率升高(P<0.05);试验组 6min、12min、24min及 36min时IPP水平均低于对照组(P<0.05);术后 2d、3d、4d及 5d时,试验组的发热低于对照组(P<0.05);术后 1d、2d、3d、4d时试验组的尿蛋白水平低于对照组(P<0.05);与对照组相比,试验组患者血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)水平降低,Hb水平均升高(P<0.05);试验组的不良反应发生率低于对照组(P<0.05).结论 超微通道经皮肾镜碎石术中监测并调控肾盂内压力有利于减少泌尿系结石患者术后发热,同时可降低尿蛋白表达减少肾功能损伤,并可控制不良反应的发生.
Objective To investigate the application of intra pelvic pressure(IPP)in ultramicro-channel percutaneous nephrolithotripsy.Methods From January 2022 to January 2023,60 patients with urinary calculi who needed Super mini-PCNL(SMP)in The First Hospital of Jiaxing selected as the study objects.According to random number method,the patients were divided into control group and experimental group,with 30 cases.Both groups were treated with ultra-micro channel percutaneous nephrolithotripsia,while the experimental group was monitored and regulated IPP in real time during the operation,and observed and compared clinical indicators,IPP,fever,urinary protein,renal function,hemoglobin(Hb)and adverse reactions between the two groups.Results Compared with the control group,the hospitalization time of experimental group was shortened and the stone clearance rate was increased(P<0.05).The IPP levels of experimental groups at 6min,12min,24min and 36min were lower than those of control group(P<0.05).The fever of experimental group was lower than that of control group at 2d,3d,4d and 5d after operation(P<0.05).The urinary protein level of experimental group was lower than that of control group at 1d,2d,3d and 4d after operation(P<0.05).Compared with control group,blood urea nitrogen(BUN)and serum creatinine(SCr)levels of experimental group were decreased,and Hb levels were increased(P<0.05).The incidence of adverse reactions in experimental group was lower than that in control group(P<0.05).Conclusion Monitoring and adjusting intrapelvic pressure during super-mini percutaneous nephrolithotomy is beneficial in reducing postoperative fever in patients with urolithiasis,reducing urinary protein expression and kidney function damage,and controlling the occurrence of adverse reactions.It is worth recommending.
陈斌;邬凌峰;陆林峰;曹益方;陈伟;汪雪萍;谢文华
嘉兴市第一医院/嘉兴学院附属医院泌尿外科,浙江嘉兴 314000
临床医学
泌尿系结石;超微通道经皮肾镜碎石术;肾盂内压力;发热;尿蛋白;不良反应
Urolithiasis;Supermicropercutaneous nephrolithotomy;Intrapelvic pressure;Fever;Urinary protein;Adverse reactions
《中国现代医生》 2024 (014)
60-64 / 5
浙江省嘉兴市公益性研究计划项目(2023AD31067);浙江省嘉兴市医学重点学科(2023-ZC-013)
10.3969/j.issn.1673-9701.2024.14.014
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