CAJ | 학술논문

【目的】探讨俯卧位下自制U形骨垫在经皮肾镜取石术（PCNL）的临床应用价值。【方法】回顾性分析本院2008年7月至2012年12月收治的行PCNL术128例患者的临床资料，其中男101例，女27例，将其随机分为观察组（ n ＝64）和对照组（ n ＝64）。观察组俯卧位下行 PCNL术时给予本院自制 U 形骨垫支撑，对照组则不给予自制U形骨垫支撑。观察并记录两组患者术中平均动脉压（MAP），心率（HR），呼吸频率（RR），手术时间，大出血发生例数，术后结石残留情况。【结果】观察组患者均穿刺成功，术中无一例需要中转气管插管全麻，无一例因呼吸及循环系统问题终止手术；对照组有2例术中转气管插管全麻，1例因呼吸及循环系统问题终止手术，两组比较均有显著性差异（均 P ＜0．05）。与对照组相比，观察组MAP、HR及RR均低于对照组，差异均有统计学意义（均 P ＜0．05）。观察组大出血及结石残留发生率均低于对照组，差异均有统计学意义（均 P＜0．05）。【结论】自制U形骨垫降低了俯卧位下行PCNL术对患者循环及呼吸系统的不良影响，提高了患者术中体位耐受程度，降低术中大出血的风险，减少了结石残留率，有一定的临床应用价值。
【목적】탐토부와위하자제U형골점재경피신경취석술（PCNL）적림상응용개치。【방법】회고성분석본원2008년7월지2012년12월수치적행PCNL술128례환자적림상자료，기중남101례，녀27례，장기수궤분위관찰조（ n ＝64）화대조조（ n ＝64）。관찰조부와위하행 PCNL술시급여본원자제 U 형골점지탱，대조조칙불급여자제U형골점지탱。관찰병기록량조환자술중평균동맥압（MAP），심솔（HR），호흡빈솔（RR），수술시간，대출혈발생례수，술후결석잔류정황。【결과】관찰조환자균천자성공，술중무일례수요중전기관삽관전마，무일례인호흡급순배계통문제종지수술；대조조유2례술중전기관삽관전마，1례인호흡급순배계통문제종지수술，량조비교균유현저성차이（균 P ＜0．05）。여대조조상비，관찰조MAP、HR급RR균저우대조조，차이균유통계학의의（균 P ＜0．05）。관찰조대출혈급결석잔류발생솔균저우대조조，차이균유통계학의의（균 P＜0．05）。【결론】자제U형골점강저료부와위하행PCNL술대환자순배급호흡계통적불량영향，제고료환자술중체위내수정도，강저술중대출혈적풍험，감소료결석잔류솔，유일정적림상응용개치。
[Objective]To explore the values of prone position plus self‐made U‐shape bone pad during per‐cutaneous nephrolithotomy (PCNL) .[Methods]Retrospective analyses were conducted for the clinical data of 128 cases of renal and upper ureteral calculi .There were 101 males and 27 females .They were randomly divid‐ed into observation and control groups ( n=64 each) .U‐shape bone pad support was offered only for observa‐tion group .And supine blood pressure ,heart rate and respiratory rate were monitored for both groups .[Re‐sults] In observation group ,puncture was successful in all patients .None of them required an intra‐operative conversion into general anesthesia with intubation or paused operation because of respiratory or circulatory problems .In control group ,two cases were converted into general anesthesia with intubation .One case termi‐nated operation because of respiratory or circulatory problems .And the inter‐group differences were statistical‐ly significant (both P<0 .05) .As compared with control group ,the levels of mean arterial pressure (MAP) , heart rate (HR) and respiratory rate (RR) were all lower in observation group .And the differences were sta‐tistically significant (both P <0 .05) .And the incidences of major hemorrhage and residual calculi were lower in observation group .And the differences were statistically significant (both P <0 .05) .[Conclusion] Use of self‐made U‐shape bone pad minimizes the adverse effects of prone position PCNL on circulatory and respirato‐ry systems in patients .And it boosts position tolerance ,reduces the risks of major hemorrhage and lowers the rate of residual calculi .