摘要
目的探讨经皮肾镜碎石术术中灌流液吸收及其对血循环和血生化的影响。方法ASAⅠ、Ⅱ级经皮肾镜碎石术患者31例,采用0.9%NaCl为灌流液。麻醉前、灌流前及术中每30分钟为记录时间点,监测血压(MBP)、心率(HR)、中心静脉压(CVP);胸电生物阻抗法连续监测心输出量(CO)、每搏输出量(SV)、胸腔液体含量(TFC)、外周阻力(SVR);术前、术后动脉血气分析测血酸碱度(pH)、Na+、K+、Cl-、阴离子间隙(BE)。结果灌流时间平均(172.41±60.84)min,灌流液用量12000～61000mL。HR、CO、SV、SVR变化灌流前后差异无显著性;MBP、CVP、TFC逐渐增高,与灌流前比差异有显著性,TFC与手术时间、灌流液量呈线性正相关。血Na+、K+、Cl-的浓度术前术后差异无显著性,术后44%患者出现代谢性酸中毒。1例肾实质损伤大的病人TFC、CVP急剧增加,静脉使用速尿后好转。31例患者均未出现严重并发症。结论经皮肾镜碎石术中存在灌流液吸收。灌流液吸收对器官代偿功能正常的病人不易引起血循环的显著变化,使用生理盐水作为灌流液也不会引起血生化的改变。
[Objective] To determine hemodynamics and fluid-electrolyte changes and complications associated with irrigation fluid absorption during pereutaneous nephrolithotripsy. [Methods] 31 ASA Ⅰ -Ⅱ patients undergoing percutaneous nephrolithotripsy were included in this study. 0.9% NaCl was used as irrigant. Mean blood pressure （MBP）, heart rate （HR）, central venous pressure （CVP）, cardiac output （CO）, stroke volume （SV）, systemic vascular resistance （SVR）, thoracic fluid content （TFC） were recorded before anaesthesia, before irrigation and every 30 min during irrigation, pH, Na^＋, K^＋, Cl^-, BE were determined before and after irrigation. Data were analyzed by ANOV, liner correlation analysis and paired t-test. [Results] The mean irrigation times were （172.41±60.84） min; irrigation fluid volume was 12 000-61 000 mL. HR, CO, SV, SVR, Na^＋, K^＋, Cl^- did not change significantly during and after irrigation. MBP, CVP and TFC significantly increased during irrigation. The increasing TFC were correlated with irrigation time and volume. 44% patients presented metabolic acidosis after surgery. CVP and TFC increasing rapidly in one patient with calyx injury and recovered after lasix injection. No complications were detected. [ Conclusion] Irrigation fluid absorption was observed during percutaneous nephrolithotripsy. No significant changes were found in hemodynamics and fluid-electrolyte balance when 0.9% NaCl was used as irrigant.
出处
《中国内镜杂志》
CSCD
北大核心
2006年第7期686-688,691,共4页
China Journal of Endoscopy
关键词
经皮肾镜碎石术
血生化
液体吸收
监测
血流动力学
上尿路结石
percutaneous nephrolithotripsy
irrigation
fluid absorption
monitor
hemodynamics
upper urinary tract calculus
