背景::近红外光谱(NIRS)监测显示肾血流量,灌注,和氧合变化。本研究旨在使用肾脏NIRS监测来评估儿科腔内干预(PEI)对区域氧饱和度值(rSO2)的影响。
方法:双侧腹股沟手术患者(I组),膀胱镜检查(II组),和输尿管肾镜检查(组III),每组20名患者,包括在研究中。诱导前(T0)和5分钟时(T5)的NIRS值,10分钟(T10),15分钟(T15),20分钟(T20),25分钟(T25),30分钟(T30)的外科手术,并在拔管后(Tend)进行测定。在组II和组III中记录冲洗液的量。输尿管肾镜组也被评估为两个亚组,作为III-R组,患者具有\“20%△rSO2\”和作为III-NoR组,没有\“20%*rSO2\”。
结果:第III组的平均总灌溉量较高,但III-R和III-NoR亚组之间差异不显著。在第III组中,肾脏rSO2在T25,T30和T端值方面显着降低。在II组中的1例患者和III组中的7例患者中出现了“20%·rSO2”。在III-R亚组中,所有患者均有梗阻性病理和明显的术前肾积水,平均肾盂AP直径为21.1±16.4mm。
结论:尽管rSO2在术后明显改善,我们的数据可能表明先天性和获得性阻塞性肾积水,持续冲洗延长手术时间,狭窄管腔内的器械运动可能会增加肾内压力和腔内泌尿外科干预中肾脏缺氧的风险。术前评估肾功能和精心计划的干预可以预防可能的并发症。
BACKGROUND: : Near-infrared spectroscopy (NIRS) monitoring demonstrates renal blood flow, perfusion, and oxygenation changes. This study aimed to evaluate the effects of pediatric endourological interventions (PEI) on regional oxygen saturation value (rSO2) usingrenal NIRS monitoring.
METHODS: Patients having bilateral inguinal surgery (group I), cystoscopy (group II), and ureterorenoscopy (group III), 20 patients in each group, were included in the study. NIRS values before induction (T0) and at 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), 30 min (T30) of the surgical procedure, and at the postextubation (Tend) were determined. The amount of irrigation fluid was recorded in groups II and III. The ureterorenoscopy group was also evaluated as two subgroups, as group III-R with patients having a \"20%↓rSO2\" and as group III-NoR, not having a \"20%↓rSO2\".
RESULTS: The mean total volume of irrigation was higher in group III, but the difference was not significant between the subgroups III-R and III-NoR. Renal rSO2 decreased significantly in T25, T30, and T-end values in group III. \"20%↓rSO2\" was seen in 1 patient in group II and 7 patients in group III. In the subgroups III-R, all patients had an obstructive pathology and significant preoperative hydronephrosis with a mean renal pelvis AP diameter of 21.1 ± 16.4 mm.
CONCLUSIONS: Although rSO2 significantly improves postoperatively, our data may suggest that congenital and acquired obstructive pathologies with hydronephrosis, prolonged operative time with continuous irrigation, and instrument movement in a narrow lumen may increase intrarenal pressure and the risk of renal hypoxia in endourological interventions. Preoperative evaluation of kidney functions and a meticulously well-planned intervention can prevent possible complications.