Abstract:

Objective

To discuss the possibility， application value and mechanism of blood pressure regulation in the treatment of massive hemorrhage after percutaneous nephrolithotomy （PCNL）.

Methods

In patients with massive hemorrhage after PCNL， the blood pressure was regulated to 10%-20% below the normal basal blood pressure after conventional conservative treatment was ineffective，recording the changes of 24-hour urine volume， blood creatinine and hemoglobin of the patients postmanagement， comparing the color changes of urinary catheter and renal fistula drainage fluid before and after regulation.It is considered successful when the color of urine becomes lighter or the red and yellow stratification is observed.The blood pressure changes before and after successful regulation of hemostasis were compared.

Results

In this study， all the 10 cases were successful.Compared with the baseline blood pressure， the reduction of systolic blood pressure and diastolic blood pressure after adjustment was 15.6% and 14.4%， respectively.After 8-24 hours， the drainage fluid from the urinary catheter became significantly lighter and stratified， and no obvious gross hematuria after 48 hours， the nephrostomy tube was opened and the drainage fluid became basically clear， and there was no intermediate open surgery or renal artery embolization， and the patients recovered well.

Conclusions

Physiological hypotension regulation is safe and feasible， fully protecting nephron， avoiding reoperation or interventional treatment， saving hospitalization cost， and improving the success rate of surgery， especially suitable for hospitals lacking vascular interventional techniques.

Key words: Regulate blood pressure, Percutaneous nephrolithotomy, Postoperative hemorrhage, Nephron protection, Conservative management