低压重力滴注法与灌注泵灌注法在经皮肾镜取石术中肾盂输尿管内压及感染相关指标的对比

摘要

目的 探讨经皮肾镜取石术(pereutaneous nephrolithotomy,PCNL)中低压重力滴注法与灌注泵灌注法对患者肾盂输尿管内压及感染相关指标的影响.方法 对2015年4月至2017年6月收治的107例肾及输尿管结石患者行PCNL治疗,以随机数字表法随机分为2组,2组患者的性别、年龄、术前泌尿系感染情况、肾积水程度、结石直径、结石位置等等比较差异均无统计学意义(P>0.05),分别为采用低压重力滴注法组61例和采用灌注泵灌注法46例.逆行置入肾盂内的F5输尿管导管连接测压系统连接监护仪测压通道,监测2组PCNL术中肾盂输尿管内平均压力及最高压力.比较2组肾盂输尿管内平均压力及最高压力、结石碎石取石时间、血红蛋白下降值、术后体温、降钙素原及白细胞异常值等指标.结果 低压重力滴注法组和灌注泵灌注法组在碎石期间肾盂及输尿管内平均压力(22.7±4.6) mmHg (1 mmHg=0.133 kPa)和(29.8±5.3) mmHg及最高压力分别为(28.8±6.56) mmHg和(50±9.25) mmHg,组间比较差异有统计学意义(P＜0.05).低压重力滴注法组和灌注泵灌注法组术后体温[4.9%(3/61) vs 17.3%(8/46) ]、降钙素原值[3.2%(2/61) vs 15.2%(7/46) ]、白细胞值[9.8%(6/61) VS.28.26%(13/46) ]比较差异均有统计学意义(P＜0.05);血红蛋白下降值[(8.3±3.7) g/L vs (7.2±3.3) g/L]结石清除时间[(42.4±14.5) min vs(43.6±13.5) min]比较差异均无统计学意义(P>0.05).结论与灌注泵灌注法比较,低压重力滴注法术中肾盂输尿管内压明显低于发生反流的极限值,术后感染指标低,发热率低;手术时间,碎石取石效果方面无明显劣势.%Objective To compare intrarenal pelvic pressure or endoureteral pressure and infection index between perfusion pump and low pressure of gravity drip during percutaneous nephrolithotomy (PCNL). Methods From 2015 April to 2017 June, 107 patients with ureteral or renal calculus were randomly divided into two groups, among whom 46 cases underwent perfusion pump PCNL and 61 cases underwent low pressure gravity drip PCNL. No statistical significance of preoperative variables was found between the two groups such as age, gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P＞0.05).A 5Fr ureteral catheter was positioned into the renal pelvic or ureter,and the intrarenal pelvic or endoureteral pressure was measured by anesthesia monitor during PCNL for all patients.We recorded and compared removing calculus time, postoperative hemoglobin changing, fever rate, procalcitonin abnormal rate, white blood cell counts and calculi clearance rate.Results The average pelvic or endoureteral pressures in the group undergoing perfusion pump and the one undergoing low pressure gravity drip were (22.7±4.6) mmHg VS (29.8±5.3) mmHg and the maximum pressure were (28.8 ±6.56) mmHg VS (50 ±9.25) mmHg.The statistics was significantly different (P＜0.05).Compared with perfusion pump group, the group undergoing low pressure gravity drip had significant differences in fever rate [4.9%(3/61) VS.17.3%(8/46) ], procalcitonin abnormal rate [3.2%(2/61) VS. 15.2%(7/46) ] and white blood cell counts abnormal rate[9.8%(6/61) VS.28.26%(13/46) ] (P＜0.05). However,no significant difference was seen in postoperative hemoglobin changing[(8.3±3.7) g/L VS.(7.2 ± 3.3) g/L] (P＞0.05) and the time of removing calculus [(42.4 ±14.5) min VS (43.6 ±13.5) min] (P＞0.05) .Conclusions Compared with perfusion pump, low pressure gravity drip PCNL maintains lower renal pelvic or endoureteral pressure, which is less than reflux limit during calculi fragmentation. It might be contributed to reduce the postoperative fever rate, white blood cell counts abnormal rate and procalcitonin abnormal rate. Hemoglobin changing and the time of removing calculus show no obvious disadvantage.