Clinical application and observation of intrarenal pelvic pressure monitoring in flexible ureteroscopic lithotripsy
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摘要: 目的:通过监测输尿管软镜碎石术中肾盂内压力(intrarenal pelvic pressure,IPP)来协助控制术中灌注压力并观察其临床效果。方法:分析我院2019年6月—2020年5月行输尿管软镜碎石术的78例患者临床资料。设定IPP＞30 mmHg为肾盂高压(IPPmax),累计IPPmax＜10 min为A组,累计IPPmax≥10 min为B组,其中IPPmax持续时间＜1 min视为瞬时压力变化,不纳入统计。比较两组术前、术后2 h及术后次晨血常规、降钙素原以及术前、术后1周的血β2微球蛋白、尿微量白蛋白数据。结果:78例均顺利完成手术,其中5例因结石负荷大分期手术。所有手术均顺利放置软镜导入鞘,平均手术时间(47.2±15.7) min。术后2例患者出现发热,无严重并发症发生。结论:通过输尿管软镜导入鞘放置F4输尿管导管连接麻醉监护仪动脉血压传感器是一种安全简便的IPP监测方法,可以及时反馈给手术医生协助控制灌注压力以降低术后并发症的概率。Abstract: Objective: To observe the clinical effects by monitoring the intrarenal pelvic pressure(IPP) and controlling the perfusion pressure during flexible ureteroscopic lithotripsy.Methods: The clinical data of 78 patients who underwent flexible ureteroscopic lithotripsy in our hospital from June 2019 to May 2020 were analyzed. The maximum intrarenal pelvic pressure(IPPmax) was set as 30 mmHg. The duration of the cumulative IPPmax less than 10 minutes was regarded as group A, while the cumulative IPPmax greater than 10 minutes as group B. However, the duration of IPPmax less than 1 minute was not included in the statistics because of an instantaneous pressure change. The white blood cell count, procalcitonin will be recorded before and after the operation, and the serum β2-microglobulin and urine albumin will also be recorded before and after operation. All the data will be compared between the two groups.Results: All the 78 cases were successfully finished the operation, of which 5 cases were operated by stages due to a large stone burden. The ureteral access sheath was successfully placed in all operations and the average operation time was(47.2±15.7) min. Two patients developed fever after operation, but no serious complications occurred.Conclusion: It is a safe and simple method to monitor the internal renal pelvic pressure using F4 ureteral catheter connected to the arterial blood pressure sensor of the anesthesia monitor through the ureteral access sheath. It can provide real-time IPP feedback to the surgeon, and help control the perfusion pressure to reduce the the incidence of complications.
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