目的 探讨B超引导下注入聚桂醇对单纯性肾囊肿患者应激相关指标的影响.方法 将2014年11月至2015年11月武汉科技大学附属医院收治的单纯性肾囊肿患者86例按随机数表法分为观察组与对照组各43例,对照组采用无水乙醇为硬化剂,观察组采用聚桂醇为硬化剂,比较两组围术期应激相关指标、临床疗效及不良反应.结果 两组患者术后12 h各应激指标水平除舒张压外均明显高于其余各时段的检测水平,且差异有统计学意义(P<0.05).其中观察组术后48 h血清应激指标血清皮质醇(Cor)[(201.22±16.27)ng/mL vs(199.58±23.47)ng/mL]、肾上腺素(AD)[(0.14±0.05)ng/mL vs(0.14±0.03)ng/mL]、去甲肾上腺素(NE)[(267.09±20.54)ng/mL vs(262.17±19.98)ng/mL]及血管紧张素Ang-Ⅱ[(51.34±6.84)pg/mL vs(49.99±6.78)pg/mL]及体征应激指标体温[(36.2±0.4)℃vs(36.3±0.2)℃]、收缩压[(121.6±13.8)mmHg vs(120.3±14.5)mmHg]及血糖[(5.2±0.9)mmol/L vs(4.9±0.7)mmol/L]与术前水平比较差异均无统计学意义(P<0.05).对照组术后72 h血清应激指标Cor[(203.22±18.01)ng/mL vs(201.47±20.13)ng/mL]、AD [(0.15±0.04)ng/mL vs(0.15±0.03)ng/mL]、NE[(267.10±21.45)ng/mL vs(264.54±21.38)ng/mL]及Ang-Ⅱ[(49.86± 6.25)pg/mL vs(50.65±5.67)pg/mL]及体征应激指标体温[(36.2±0.1)℃vs(36.2±0.3)℃]、收缩压[(122.9±13.2)mmHg vs(123.4±11.3)mmHg]及血糖[(5.2±0.8)mmol/L vs(5.1±0.6)mmol/L]与术前水平比较差异均无统计学意义(P>0.05).观察组患者临床治疗的总有效率为93.0%,明显高于对照组的69.8%,差异有统计学意义(P<0.05);观察组发生过敏及血尿例数与对照组比较差异无统计学意义(P>0.05),而观察组出现腰部酸胀(4.7%)及发热(2.3%)的比例明显低于对照组(20.9%、25.6%),且差异具有统计学意义(P<0.05).结论 采用聚桂醇为硬化剂对单纯性肾囊肿患者进行B超引导治疗,不仅能够对各应激指标有调节作用,同时能提高疗效,降低不良反应发生率.%Objective To study the influence of ultrasound-guided injection of lauromacrogol on the stress re-sponse of patients with simple renal cyst.Methods Eighty-six patients with simple renal cyst from November 2014 to No-vember 2015 in our hospital divided into observation group(n=43)and control group(n=43),which received lauromacro-gol and absolute ethyl alcohol as sclerosis,respectively.The stress response indexes,clinical effect and side effect in of two groups were compared.Results The levels of stress response indexes(except diastolic pressure)12 h after operation were all significantly higher than the levels at other time points (P<0.05). The levels of stress response indexes of cortisol (Cor), adrenalin (AD), noradrenalin (NE), Ang-Ⅱ, body temperature, systolic pressure, and blood sugar 48 h after operation in the observation group showed no statistically significant difference with those before operation (P>0.05): Cor (201.22 ± 16.27) ng/mL vs (199.58±23.47) ng/mL,AD (0.14±0.05) ng/mL vs (0.14±0.03) ng/mL, NE (267.09±20.54) ng/mL vs (262.17± 19.98) ng/mL, Ang-Ⅱ(51.34±6.84) pg/mL vs (49.99±6.78) pg/mL, body temperature (36.2±0.4)℃ vs (36.3±0.2)℃, systolic pressure (121.6±13.8) mmHg vs (120.3±14.5) mmHg, and blood sugar (5.2±0.9) mmol/L vs (4.9±0.7) mmol/L. The levels of stress response indexes of Cor, AD, NE, Ang-Ⅱ, body temperature, systolic pressure, and blood sugar in the control group 72 h after operation were also not significantly different from those before operation (P>0.05): Cor (203.22±18.01) ng/mL vs (201.47±20.13) ng/mL, AD (0.15±0.04) ng/mL vs (0.15±0.03) ng/mL, NE (267.10±21.45) ng/mL vs (264.54±21.38) ng/mL, Ang-Ⅱ(49.86±6.25) pg/mL vs (50.65±5.67) pg/mL, body temperature (36.2±0.1)℃ vs (36.2±0.3)℃, systolic pressure (122.9±13.2) mmHg vs (123.4±11.3) mmHg, blood sugar (5.2±0.8) mmol/L vs (5.1±0.6) mmol/L. Compared with the control group, the observation group had significant higher total clinical effective rate (93.0% vs 69.8%, P<0.05). The allergies and hematuria cases in observation group and control group had no significant difference (P>0.05). The incidence of swollen and fever were 4.7%, 2.3% in the observation group versus 20.9%, 25.6% in the control group (P< 0.05). Conclusion The use of lauromacrogol as sclerosis in patients with simple renal cysts for ultrasound-guided therapy can not only regulate the stress indexes, but also improve the clinical efficacy and reduce the incidence of adverse reactions.
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