经皮肾镜术中灌注次氯酸对术后全身炎症反应综合征的临床疗效

doi:10.3877/cma.j.issn.1674-3253.2019.03.003

目的

观察经皮肾镜碎石取石术(PCNL)术中灌注1‰浓度的次氯酸（HClO）对预防术后全身炎症反应综合征（SIRS）的临床疗效。

方法

基础实验：采用MTT法和流式细胞术检测≤2.8‰浓度下的HClO对人肾小管上皮细胞和正常膀胱尿路上皮细胞增殖抑制和诱导凋亡的影响。临床试验：前瞻选取2016年6月到2017年12月于我院就诊适应于一期PCNL术的132例肾或输尿管上段结石患者作为研究对象，采用数字法随机将患者分为两组，其中术中用1‰HClO生理盐水灌注的63例患者作为观察组，术中用生理盐水常规灌注的69例患者作为对照组。观察比较观察组和对照组的术后SIRS发生情况。

结果

≤2.8‰的HClO对人肾小管上皮细胞和正常膀胱尿路上皮细胞未产生明显增殖抑制和诱导凋亡的影响（P>0.05）。在临床试验方面观察组术后SIRS的发生率9.52%，低于对照组的28.99%，差异有统计学意义（P<0.05）。

结论

PCNL术中灌注1‰浓度的HClO生理盐水对降低PCNL术后发生SIRS风险和提高患者预后疗效显著，值得在临床中进一步推广。

关键词: 经皮肾镜, 肾结石, 次氯酸, 全身炎症反应综合征

Objective

To evaluate the effectiveness of 1‰ concentration hypochlorous acid (HClO)intraoperative irrigation on prevention of postoperative systemic inflammatory response syndrome (SIRS) during percutaneous nephrolithotripsy (PCNL).

Methods

The effects of HClO at concentration≤2.8‰ on proliferation inhibition and apoptosis induction of human renal tubular epithelial cells and normal bladder urothelial cells were detected by MTT assay and flow cytometry. One hundred and thirty-two patients with renal or upper ureteral stones treated in the Affiliated Hospital of Xuzhou Medical College from June 2016 to December 2017 suitable for one-stage percutaneous nephrolithotomy (PCNL) treatment were proactively chosen and randomly divided into trial group (treated with 1‰ HClO ) and control group (treated with NS) by random number table method. The rate of SIRS between two groups was analyzed and compared.

Results

HClO≤2.8‰ did not significantly inhibit proliferation and induce apoptosis in human renal tubular epithelial cells and normal bladder urothelial cells (P>0.05). The incidence of postoperative SIRS in the trial group (9.52%) was lower than that in the control group (28.99%).

Conclusion

Intraoperative irrigation of 1‰ HClO in PCNL is significant for prevention of postoperative SIRS and postoperative prognosis of patients. It is worth further clinical application.

Key words: PCNL, Kidney stones, Hypochlorous acid, SIRS

表1 观察组和对照组一般资料比较

组别	例数	年龄（岁，±s）	性别（例）		BMI>24kg/m²（例）	糖尿病（例）	手术时间（min，±s）	手术通道[例（单∶多）]
组别	例数	年龄（岁，±s）	男	女	BMI>24kg/m²（例）	糖尿病（例）	手术时间（min，±s）	手术通道[例（单∶多）]
观察组	63	46±11	35	28	37	17	86±8	60∶3
对照组	69	46±11	37	32	44	22	85±8	64∶5
统计值	?	t=0.077	χ²=0.050		χ²=0.353	χ²=0.380	t=0.848	-
P值	?	0.939	0.824		0.553	0.538	0.398	0.720
组别	例数	结石大（cm³，±s）	术中出血（ml，±s）	尿培养[例（阳∶阴）]	抗生素[例（是∶否）]	结石细菌培养[例（阳∶阴）]
观察组	63	3.6±0.7	85±10	20∶43	42∶21	31∶32
对照组	69	3.5±0.9	86±12	22∶47	43∶26	35∶34
统计值	?	t=5.040	χ²=0.767	χ²=0.000	χ²=0.272	χ²=0.030
P值	?	0.615	0.444	0.986	0.602	0.862

表1 观察组和对照组一般资料比较

组别	例数	年龄（岁，±s）	性别（例）		BMI>24kg/m²（例）	糖尿病（例）	手术时间（min，±s）	手术通道[例（单∶多）]
组别	例数	年龄（岁，±s）	男	女	BMI>24kg/m²（例）	糖尿病（例）	手术时间（min，±s）	手术通道[例（单∶多）]
观察组	63	46±11	35	28	37	17	86±8	60∶3
对照组	69	46±11	37	32	44	22	85±8	64∶5
统计值	?	t=0.077	χ²=0.050		χ²=0.353	χ²=0.380	t=0.848	-
P值	?	0.939	0.824		0.553	0.538	0.398	0.720
组别	例数	结石大（cm³，±s）	术中出血（ml，±s）	尿培养[例（阳∶阴）]	抗生素[例（是∶否）]	结石细菌培养[例（阳∶阴）]
观察组	63	3.6±0.7	85±10	20∶43	42∶21	31∶32
对照组	69	3.5±0.9	86±12	22∶47	43∶26	35∶34
统计值	?	t=5.040	χ²=0.767	χ²=0.000	χ²=0.272	χ²=0.030
P值	?	0.615	0.444	0.986	0.602	0.862

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The clinical effectiveness of 1‰ concentration hypochloric acid (HClO) in percutaneous nephrolithotripsy on the prevention of postoperative systemic inflammatory response syndrome

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The clinical effectiveness of 1‰ concentration hypochloric acid (HClO) in percutaneous nephrolithotripsy on the prevention of postoperative systemic inflammatory response syndrome