经皮肾镜超声碎石术术中监测肺功能和中心静脉压的临床意义

目的 在经皮肾镜超声碎石术(PCNL)期间观察中心静脉压和肺功能,预防可出现的灌流液吸收综合征.方法 选择ASAⅠ或Ⅱ级择期上尿路结石经皮肾镜超声碎石术病人60例,采用全凭静脉麻醉.选麻醉前、手术前及术中每30min为记录时间点.纪录中心静脉压(CVP),肺顺应性(Cs)、动态肺顺应性(Cd)、呼吸指数(RI).结果 60例患者中56例顺利完成手术,CVP、RI在T1-5各时段呈递增趋势,Cs,Cd在T1-5各时段呈递减趋势,并在T3-5变化显著,有4例出现灌流液吸收综合征.结论 CVP、RI随手术时间的延长而升高;Cs、Cd随手术时间的延长而减低;当手术时间＞2h,并发症明显增多,应尽快结束手术.

Clinical value of monitoring the lung function and central venous pressure during percutaneous nephrostomy and ultrasound lithotripsy

Objective Abstract Objective To explore the clinical effects of preveting possible perfusate absortion syndrome. Methods 60 patients with upper lithangiuria of ASA I or I grade underwent pereutaneous nephrostomy and ultrasound lithotripsy. The preanesthesia,preoperation and every 30 min were taken as recording time point. CVP, Cs,Cd,RI were recorded. Results 56 of the 60 patients underwent the operation successfully, CVP,RI showed an increasing trend at T1 -5 time points, Cs,Cd showed decreasing trend at T1 - 5 time points and there was significant changes at T3 - 5. Perfusate absorption syndrome occurred in 4 cases. Conclusions CVP,RI increase while Cs,Cd decrease as operation time prolongs. More complications are likely to occur as operation time prolongs, which indicates a quick finish of the operation for safety.