体外冲击波碎石

一、前言 体外冲击波碎石术(Extracorporeal Shock Wave Lithotripsy-ESWL)是一种非手术治疗结石症的新方法。在治疗中,它以安全、有效、操作简单等特点而受到医生和结石患者的欢迎。 在人体内的体腔、管状组织和囊状器官中的结石是由于饮食无规、代谢失常、尿路梗阻及感染等原因形成的,它以有机物为核心,由矿物与盐类沉积而成。按结石的形成部位,可分为肾结石、输尿     

体外冲击波碎石的护理

体外冲击波碎石(ESWL)是八十年代医学界一项最新进展,开创了人类外科史上非手术治疗泌尿系结石的新纪元。1980年2月德国慕尼黑大学教授Chaussy首先成功地使用碎石机治疗肾结石,1985年底我国也开始了这项工作,且发展迅速。目前国内已有     

盲目体外冲击波碎石3例严重并发症临床分析

目的探讨体外冲击波碎石治疗尿路结石中并发症发生的原因及其防治措施。方法对本院近年收治的3例行尿路结石体外冲击波碎石治疗后发生并发症的病例进行回顾分析。结果 1例肾结石碎石后感染未控制再次碎石致败血症死亡,1例肾铸形结石伴重度积水碎石后致肾破裂行患肾切除,1例输尿管上段结石反复碎石20余次无效行开放手术。结论体外冲击波碎石是治疗尿路结石的有效方法之一。只有严格掌握体外冲击波碎石治疗的适应证,坚持体外冲击波碎石的治疗原则,充分做好体外冲击波碎石前的准备,才能避免盲目碎石,有效减少并发症。     

体外冲击波碎石术治疗胆囊结石

体外冲击波碎石术治疗胆囊结石河南省人民医院（４５０００３）董守元体外冲击波碎石术自１９８６年国外报道正式用于胆道结石治疗获得成功以后，各国相继应用这项新技术。在治疗胆囊结石方面积累了丰富的经验。目前我国许多医院采用Ｅｓｗ１碎石术治疗胆囊结石，取得了可...     

体外震波碎石治疗泌尿系结石：附550例报告

1980年Chaussy首先将体外震波碎石机应用于临床,对泌尿系统结石的治疗产生了根本性的改变。绝大多数泌尿系统结石可以不再经过手术即被粉碎排出,解除了梗阻,保护了肾功。这样既免除病人开刀的痛苦,又节省了住院时间,所以深受患者的欢迎。1988年12月～1989年6月。我院采用国产KDE—Ⅰ型水囊式体外震波碎石机,共治疗了泌尿系结石患者550例,取得满意效果,现报告如下。     

体外震波碎石病人并发症的预防教育

对泌尿系体外震波碎石病人开展并发症预防教育的目的是要使病人＂知＂、＂信＂、＂行＂。教育的方法有集体教育，即采用自编宣传册和定期宣教；个体教育有术前教育和针对性教育。教育的内容主要有饮水、运动和体位引流三方面。经过３年的临床实践表明，预防教育可减少体外震波碎石后发生可避免的并发症，提示在临床护理中应进一步加强和重视这方面的教育。     

低能量多方位体外震波治疗泌尿系结石（附1136例报告）

本文报道1998年5月～2005年10月采用低能量多方位治疗泌尿系结石1136例的经验。结石碎石率为98．4％，震波电压为55～7.7Kv，震波次数为1500～2500次之间。治疗一次者983例，二次为113例，三次为20例，四次为2例，失败18例。本文就低电压多个方位体外震波进行讨论。     

体外冲击波对犬胆囊区组织损伤实验观察

用体外冲击波碎石术（ＥＳＷＬ），冲击２０只犬的胆囊区，即刻、２、４、８周后分组切取受冲击部肝脏、胆囊组织，观察发现，冲击电压高，频率快局部组织急性出血损伤明显，损伤恢复期延长。８周后仅１只犬肝细胞脂肪变，余者基本恢复正常，说明ＥＳＷＬ主要以胆囊及周围脏器急性损伤为主。熟练掌握ＥＳＷＬ性能，尽量减少重复碎石次数是减轻组织损伤，有利于组织恢复的重要因素。     

The Effects of Extracorporeal Shock Wave Lithotripsy on Pacemaker Function

Twenty-two pacemaker pulse generators were exposed to shock waves of an extracorporeal shock wave lithotripter to assess the effects of the extremely high pressure transients on pacemaker function. The pulse generator and distal aspect of the lead were positioned 5 cm from the focal point of the lithotripter and 10 cm from each other. Pulse generator function was analyzed during shock wave delivery synchronized with pulse generator output, during shock waves at a rate faster than the escape rate, and after exposure to lithotripsy. During shock waves delivered synchronously with pulse generator output, only one of 22 pulse generators malfunctioned by intermittently reverting to the magnet rate. When subjected to shock waves at a rate greater than the escape rate, 50% of the pulse generators were inhibited by electromechanical interference from the lithotripter. Both bipolar and unipolar devices were affected. However, analysis after exposure to shock waves showed that none of the pacemakers was damaged or spuriously reprogrammed. In conclusion, cardiac pacemakers do not appear to be damaged or reprogrammed by exposure to extracorporeal shock wave lithotripsy. The likelihood of false inhibition appears to be very low if shock waves are delivered synchronously with the QRS.     

体外冲击波碎石术治疗尿路结石(附2 725例报告)

目的：探讨体外冲击波碎石术(ESWL)治疗尿路结石的有效性和安全性。方法：结合文献，回顾分析1993-2004年采用ESWL治疗尿路结石患者2725例，其中肾结石922例，输尿管结石1789例，膀胱结石14例。结果：随访3个月，结石排净率94．4％(2572／2725)，结石残留109例(4．0％)，16例无效(0．6％)，改用手术治疗。结论：ESWL具有治疗成功率高、副作用少、无严重并发症的优点，是治疗尿路结石安全、有效的方法。     

Effects of Extracorporeal Shock Wave Lithotripsy on Cardiac Pacemakers and its Safety in Patients with Implanted Cardiac Pacemakers

Ejects of extracorporeal shockwave lithotripsy (ESWL) were studied on 15 pacemakers (standard single chamber n = 5, dual chamber n = 6, rate responsive single chamber [Activitrax] n = 4). In-vitro testing involved suspending the pacemakers in a bath of degassified, deionized water firmly taped to a platform at the point of maximal pressure, i.e., second focal point (F2), where they received pressure shocks (x?= 1300) from the HM3 Dornier lithotriptor. The pacemakers, programmed to their most sensitive setting, were continuously pacing at nominal outputs (atria) and ventricular pacing in the DDD mode). All units were assessed by a pacing system analyzer before and after the study, then underwent destructive analysis. During standard single chamber pacing (VVI) the pacing stimulus triggered ESWL. For dual chamber devices, ESWL was triggered by the atrial paced event which induced inhibition of the ventricular output in two pacemaker. This was eliminated by reprogramming to a less sensitive setting. The pacemaker can, hermetic seal and internal circuitry were undamaged in all units. Two rate responsive single chamber pacemakers had their activity sensing piezoelectric elements shattered when placed at F2. Two other units placed 5 cm from F2 were stimulated to their maximum upper programmed pacing rate with ESWL therapy, but were otherwise unaffected. Subsequent to this study, six patients with pacemakers programmed to the VVI (five), DDD (one) modes implanted in the thorax underwent successful ESWL without pacemaker or arrhythmic event. Conclusions: (A) It is generally safe for patients implanted with standard single chamber devices in a ventricular application to undergo ESWL without modifying the pacing/sensing parameters. (B) Patients implanted with dual chamber devices who pace in the atrium should be reprogrammed to the VVI mode during ESWL. (C) Patients with piezoelectric activity sensing rate responsive single chamber pacemakers should have this feature programmed off during ESWL and, if implanted in the abdomen, probably should not undergo ESWL.     

Effects of Extracorporeal Shock Wave Lithotripsy on Single Chamber Rate Response and Dual Chamber Pacemakers

This study evaluated effects of extracorporeal shock wave lithotripsy on four models of Medtronic implantable cardiac pacemakers. In vitro testing consisted of: (1) unsynchronized pacemaker strapped on the patient with extracorporeal shock synchronized to the patient's native heart rate; and (2) pacemakers suspended alone in water 6 inches from the focal point, synchronizing the extracorporeal shock to pacemaker output. Unsynchronized shocks affected each model of pacemaker differently, i.e., single chamber constant rate pacemakers experienced extended periods of inhibition for more than three pacing cycles while activity-triggered rate response pacemakers exhibited rate increases to the upper rate setting. Dual chamber synchronous pacemakers exhibited intermittently a 59% decrease and a 20% increase in ventricular rate due to inhibition and triggering, respectively, from shock oversensing. Synchronized shocks did not alter the rate of single chamber constant rate pacemakers, but did cause the rate to increase to the upper rate setting for activity-triggered rate response pacemakers. The shock was synchronized to the initial atrial output from the dual chamber pacemaker and caused frequent inhibition of the ventricular stimulus when the ventricular-safety-pace (VSP) feature was programmed off. Programming VSP on reduced the incidence of ventricular inhibition resulting in near normal pacemaker operation. There was neither observable damage to pacemaker components nor spurious reprogramming of pacemaker parameters during the tests. Our studies with one manufacturer's pacemakers suggests that lithotripsy shock effects on implantable pacemakers can be tolerated provided: (1) the single chamber pacemaker is programmed to the demand constant rate modality; (2) the dual chamber pacemaker is programmed to VSP on or to the VVI mode; and (3) the pacemaker distance to the focal point is greater than 6 inches.(ABSTRACT TRUNCATED AT 250 WORDS)     

护理延伸服务对尿路结石患者体外冲击波碎石疗效的影响

目的研究护理延伸服务对尿路结石患者体外冲击波碎石疗效的影响。方法便利抽样法选取2010年5月至2011年5月在浦东新区公利医院首次行体外冲击波碎石术的400例尿路结石患者为研究对象,按照随机数字表法将其分为观察组和对照组,每组200例。对照组患者采用常规护理宣教,观察组患者在常规护理宣教的基础上加上出院后护理延伸服务。两组患者均进行定期随访,比较两组患者出院后的治疗效果(结石排净时间、结石碎片直径、疼痛缓解情况)、并发症发生情况、预后情况[生活质量(quality of life,QOL)评分和BI评分]及随访情况(预防结石知识的掌握程度、遵照医嘱改善生活行为、定期随访率、复发率)。结果观察组患者结石排净时间、结石碎片直径均明显低于对照组,疼痛缓解程度明显优于对照组,差异均有统计学意义(均P<0.05);观察组患者并发症的发生情况明显少于对照组,差异有统计学意义(P<0.05)。观察组QOL及BI评分均明显高于对照组,差异均有统计学意义(均P<0.05)。两组患者在随访的四项指标上的差异均有统计学意义(均P<0.05)。结论护理延伸服务能显著提高体外冲击波碎石的疗效,明显改善患者预后,提高患者术后生活质量,值得临床推广应用。     

体外冲击波碎石术前置入输尿管支架治疗输尿管结石价值的系统评价

目的系统评价体外冲击波碎石术（ESWL）前置入输尿管支架的价值。方法计算机检索Cochrane图书馆临床对照试验注册中心CCTR（2010.4）、MEDLINE（OVID,1950～2010.4）、EMbase（1966～2010.4）、CBM（1978～2010.4）、CNKI（1979～2010.4）和VIP（1989～2010.4）,手工检索相关文献,纳入在ESWL前置入输尿管支架治疗输尿管结石的随机对照试验（RCT）。按Cochrane评价员手册5.0.1版评估纳入研究的偏倚风险,并用RevMan5.0软件进行统计分析。结果共纳入3个RCT,共319例输尿管结石患者。其研究质量均为C级。Meta分析结果显示：①疗效指标：ESWL前置入输尿管支架在结石完全清除率、碎石次数、碎石冲击波频率、碎石冲击波能量方面并未表现出较好的疗效,其WMD（95%CI）分别为1.10（0.87,1.38）、0.43（–1.05,0.19）、0.00（–0.25,0.25）、0.20（–0.05,0.46）。②术后并发症发生率：ESWL前置入输尿管支架术后较易发生排尿困难、镜下血尿、肉眼血尿、脓尿、尿培养阳性、耻骨上疼痛,其RR（95%CI）分别为2.30（1.62,3.26）、2.66（1.97,3.58）、6.50（1.50,28.15）、1.78（1.44,2.21）、2.13（1.71,2.64）和3.10（1.59,6.04）,且无助于预防石街形成[RR=0.39,95%C（I0.03,4.58）]。结论现有证据表明,ESWL前置入输尿管支架的方法不可取。因纳入研究质量不高且例数较少,上述结论尚期待更多高质量的试验加以验证。