摘要:
Objective To investigate the clinical application of different puncture positions in percutaneous nephrolithotomy (PCNL).Methods From February 2015 to March 2017,102 patients with kidney urinary calculi in our hospital were enrolled in the study.According to the selected puncture position,they were divided into prone position (group A,32 cases),lateral decubitus position (group B,37 cases) and half stone oblique supine position (group C,33 cases).The mean arterial pressure (MAP),heart rate (HR) and blood oxygen saturation (SpO2) were observed before placement of 5 min (T0),after placement of 5 min (T1),30 min (T2),and postoperative 5 min (T3),and the time of established passage,the time of operation and the amount of bleeding during operation and so on.Results The MAP in group B and group C at T1 was significantly higher than that in group A (P < 0.05);The HR in Group B and group C at T2 and T3 were significantly lower than those in group A (P < 0.05);The SpO2 in Group B and group C at T1 and T2 were significantly higher than those in group A (P < 0.05);There was no significant difference in the time of establishment passage,the rate of primary clearing stone and the hospital stay in the groups (P >0.05);The operation time and intraoperative blood loss in group C were (120.07 ± 20.19) min and (90.01 ±30.11)ml,significantly less than those in group B and group A (P <0.05);The operation time and intraoperative blood loss in group B were (140.17 ±20.48) min and (110.04 ±29.82) ml,significantly less than that in group A [(170.02 ± 21.02) min,(164.02 ± 30.12) ml] (P < 0.05);The postural comfort of group C was better than that of group A and group B (P < 0.05);There was no significant difference in the incidence of postoperative complications in the three groups (P > 0.05).Conclusions Half stone oblique supine position in the PCNL application has good effect,which is conducive to improving the patient's tolerance to surgery,shorten the operation time,and it is worth popularizing.%目的 探讨不同穿刺体位在经皮肾镜碎石手术(PCNL)中的临床应用.方法 选取2015年2月至2017年3月在本院治疗的肾尿结石患者102例,根据选取的穿刺体位分为俯卧位(A组,32例)、侧卧位(B组,37例)和半截石斜仰卧位(C组,33例),观察各组体位安置前5 min(T0)、安置后5 min(T1)、30 min(T2)、手术后5 min(T3)时平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)以及建立通道时间、手术时间、术中出血量等.结果 B组和C组T1、T2和T3时MAP明显高于A组(P<0.05);B组和C组T2和T3时HR明显低于A组(P<0.05);B组和C组T1和T2时SpO2明显高于A组(P<0.05);各组建立通道时间、一次清石率和住院时间比较差异无统计学意义(P>0.05);C组手术时间和术中出血量分别为(120.07±20.19) min和(90.01±30.11)ml,明显少于B组和A组(P<0.05);B组手术时间和术中出血量分别为(140.17±20.48) min和(110.04±29.82)ml,明显少于A组[(170.02±21.02)min,(164.02±30.12) ml] (P <0.05);C组患者体位舒适度优于A组和B组(P<0.05);三组术后并发症发生率比较差异无统计学意义(P>0.05).结论 半截石斜仰卧位在PCNL中应用有较好的效果,有利于提高患者对手术的耐受,缩短手术时间,值得推广使用.