A prospective comparative study of haemodynamic, electrolyte, and metabolic changes during percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy
A prospective comparative study of haemodynamic, electrolyte, and metabolic changes during percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy
复制标题
经皮肾镜取石术与微创经皮肾镜取石术期间血流动力学、电解质和代谢变化的前瞻性比较研究
DOI：
10.1007/s00345-013-1204-2
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发表时间：
2014-10-01
影响因子：
3.4
通讯作者：
Xia, Shujie
中科院分区：
文献类型：
--
作者：
Xu, Shuxiong;Shi, Hua;Xia, Shujie
目的 报告一项前瞻性临床试验的血流动力学、电解质和代谢变化，比较微创经皮肾镜取石术 (MPCNL) 与经皮肾镜取石术 (PCNL) 治疗肾结石的情况。 方法 对总共 71 名接受过 MPCNL (37) 或 PCNL (34) 的患者进行前瞻性评估。监测心率和动脉血压，并在冲洗开始、第 30 分钟、第 60 分钟、第 90 分钟和第 120 分钟以及两次手术后 24 小时后抽取样本进行电解质评估和动脉血气分析。结果在 PCNL 组中，心率、动脉血压、电解质和 pH 值没有发生显着变化。在MPCNL组中，灌洗期间和灌洗后心率、动脉血压和血清钠水平保持稳定；灌水后第30～120分钟出现钾水平下降，直至术后24小时才恢复（P<0.05），但整个观察期间钾水平均正常；灌溉第 120 分钟时，Cl− 水平有所增加（P<0.05）；灌水开始至灌水第120分钟pH值呈下降趋势（P<0.05），灌水后24小时pH值下降趋势减弱（P<0.05）；结论与PCNL相比，虽然MPCNL期间血流动力学和电解质变化保持稳定，但随着灌洗时间的延长，代谢性酸中毒的趋势明显。因此，对于冲洗时间较长的患者，在MPCNL术中和术后应监测动脉血气。
ObjectivesTo report the haemodynamic, electrolyte, and metabolic changes of a prospective clinical trial comparing minimally invasive percutaneous nephrolithotomy (MPCNL) with percutaneous nephrolithotomy (PCNL) for renal stones.MethodsIn all, 71 patients who had undergone MPCNL (37) or PCNL (34) were prospectively assessed. Heart rate and arterial blood pressure were monitored, and samples for electrolyte estimation and arterial blood gas analysis were drawn at the start, 30th, 60th, 90th, and 120th min of irrigation and 24 h later after both procedures.ResultsIn the PCNL group, no significant changes occurred in heart rate, arterial blood pressure, electrolytes, and pH. In the MPCNL group, heart rate, arterial blood pressure, and serum sodium levels kept stably during and after irrigation; the decrease in potassium levels was found from the 30th to 120th min of irrigation and did not recovery until 24 h later after operation (P< 0.05), but the potassium levels was normal during the entire observation period; the increase in Cl−levels was noted at the 120th min of irrigation (P< 0.05); there was a decreasing trend of pH from the start to the 120th min of irrigation (P< 0.05) and 24 h later after operation this trend attenuated (P< 0.05); the changes in base excess levels were in accordance with those in pH levels.ConclusionsAlthough haemodynamic and electrolyte changes remains stable, a trend towards metabolic acidosis is obvious as the irrigation time goes by during MPCNL compared with PCNL. Therefore, arterial blood gases should be monitored during and after MPCNL in patients with prolonged irrigation time.