摘要目的 通过对微通道经皮肾镜取石术(mPNL)手术前后血流动力学、血生化和相关激素的监测,探讨mPNL术中灌注液吸收对机体的影响.方法 2007年1月至2008年2月对128例肾结石或输尿管上段结石患者实施了mPNL.手术前后监测血红蛋白、红细胞压积、血浆渗透压、血电解质、血肌酐及肾素、血管紧张素Ⅱ和醛固酮.术中每30 min动态记录心率、平均动脉压和外周血氧饱和度的变化.结果 术中患者的心率随着灌注时间延长而加快.术毕血浆渗透压、血清Cl-、肾素和血肌酐较术前增高.术毕血红蛋白、红细胞压积、血清K+较术前降低.平均动脉压、外周血氧饱和度、血清Na+、醛固酮和血管紧张素Ⅱ手术前后无明显变化.所有患者无严重并发症发生.结论 mPNL术中液体吸收的量与灌注时间呈正相关.一定量的液体吸收可引起患者血流动力学、血生化及血肾素的变化.

abstractsObjective To determine the effects of irrigation fluid absorption on system hemodynamics,fluid-electrolyte and hormone during mini-percutaneous nephrolithotomy.Methods In this study 128 patients with renal calculus or calculus of superior ureter from January 2007 to February 2008 were collected.Hemoglobin (Hb),hematocrit (Hct),plasma osmotic pressure(POP),fluid-electrolyte,serum creatinine (Cre),renin,angiotensin Ⅱ and aldosterone were determined before and after operation.Heart rate (HR) ,mean arterial blood pressure (MAP) and oxygen saturation( SPO2) were recorded dynamically every 30 min.Results The HR speeded up accompanied with the irrigation time.When compared with before operation,POP,Cl-,renin and Cre were significantly increased after operation;Hb,Hct and K+were significantly decreased after operation;MAP,SPO2,Na+,aldosterone and angiotensin Ⅱ did not change significantly after operation.No serious surgery-related complication occurred in all patients.Conclusions Irrigation fluid is absorbed during mini-percutancous nephrolithotomy.The absorption amount is positively correlated with irrigation time.Changes of hemedynamics,fluid-electrolyte balance and renin may be caused by the irrigation fluid absorption.