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[1]章尹岗,刘文.不同体位下经皮肾镜取石术对肾盂结石患者呼吸循环及应激反应的影响[J].医学研究与战创伤救治(原医学研究生学报),2018,20(04):381-385.[doi:10.3969/j.issn.1672-271X.2018.04.012]
　ZHANG Yin-gang,LIU Wen.Effects of percutaneous nephrolithotomy(PCNL) under different positions on circulation, respiration and stress response in patients with renal pelvis calculi[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(04):381-385.[doi:10.3969/j.issn.1672-271X.2018.04.012]
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不同体位下经皮肾镜取石术对肾盂结石患者呼吸循环及应激反应的影响()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年04期
页码:
381-385
栏目:
临床研究
出版日期:
2018-07-20

文章信息/Info

Title:
Effects of percutaneous nephrolithotomy(PCNL) under different positions on circulation, respiration and stress response in patients with renal pelvis calculi
作者:
章尹岗; 刘文
作者单位：431700天门，天门市第一人民医院泌尿外科（章尹岗），内分泌科（刘文）
Author(s):
ZHANG Yin-gang1; LIU Wen2
（1. Department of Urology, 2. Department of Endocrinology，Tianmen First People′s Hospital,Tianmen 431700，Hubei，China）
关键词:
体位; 经皮肾镜取石术; 结石; 影响
Keywords:
positions;  percutaneous nephrolithotomy;  calculi;  effects
分类号:
R692.4
DOI:
10.3969/j.issn.1672-271X.2018.04.012
文献标志码:
A
摘要:
目的 观察不同体位下经皮肾镜取石术（PCNL）对肾盂结石患者循环、呼吸和应激反应的影响。方法 回顾性分析104例行PCNL手术肾盂结石患者的临床资料，根据手术体位将患者分为俯卧位组和斜仰卧位组，每组52例，观察比较2组患者围术期指标及不同体位对手术前后2组患者循环系统指标[收缩压（SBP）、舒张压（DBP）及心率（HR）]、呼吸系统功能指标[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）和肺泡-动脉血氧分压差（P(A-a)O2）]和应激反应指标[促肾上腺皮质激素（ACTH）、去甲肾上腺素（NE
Abstract:
Objective To observe the effect of percutaneous nephrolithotomy (PCNL) under different positions on the circulation, respiration and stress response in patients with renal pelvis calculi.Methods The clinical data of 104 patients with renal pelvis calculi treated with PCNL surgery were retrospectively analyzed. According to the operative position, all patients were divided into the prone position group and the oblique supine position group with 52 cases in each group. The perioperative indexes and the changes of circulatory system indexes [systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)], respiratory function indexes [arterial oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2) and alveolar-arterial oxygen partial pressure difference (P(A-a)O2)] and stress response indexes [adrenocorticotropic hormone (ACTH), norepinephrine (NE), cortisol (Cor), adrenaline (AD)] of the two groups before and after operation under different positions were observed and compared between each other.Results The operative time, intraoperative blood loss, intraoperative transfusion volume in the prone position group were significantly higher than those in the oblique supine position group [（159.74±12.36）min vs （128.97±1027）min，（15042±35.18）mL vs （125.68±27.51）mL，（1489.61±258.71）mL vs （1318.71±22038）mL，P<005], while the disposable stone free rate was significantly lower than that in the oblique supine position group （78.85% vs 94.23%，P<005）. After operation, SBP andDBP indexes in the prone position were significantly lower than those before operation (P<005), while the HR index was significantly increased compared with that before operation (P<005). And there were significant differences in the levels of SBP, DBP, HR indexes between the prone position group and the oblique supine position group (P<005), but there were no significant changes in the levels of SBP, DBP and HR indexes in the oblique supine position group before and after operation (P>005). After operation, the PaO2 level of two groups was significantly lower than that before operation (P<005), and the PaO2 level in the prone position group was significantly lower than that in the oblique supine position group (P<005). But the levels of PaCO2, P(A-a)O2, ACTH, NE, Cor and AD were significantly higher than those before operation in the two groups (P<005), and the levels of PaCO2, P(A-a)O2, ACTH, NE, Cor and AD were significantly higher in the prone position group than those in the oblique supine position group (P<005).Conclusion The oblique supine position in the PCNL surgery can have a significant effect, and have small impacts on the patient’s circulatory system, respiratory system and stress response with the features of short operative time, little intraoperative blood loss and high stone removal rate in the treatment of renal pelvis calculi. Therefore, the oblique supine position in the PCNL surgery is worthy of clinical promotion and application.

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备注/Memo

备注/Memo:
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更新日期/Last Update: 2018-07-20