Effects Of The Irrigtation Fluid's Absorption On Hemodynamics, Electrolyte Balance And Hemorheology During Percutaneous Nephrolithotomy

To explore the effects of irrigation fluid's absorption on system hemodynamics, electrolyte balance and hemorheology during mini-percutaneous nephrolithotomy.Further,we plan to evaluate the safety of mini-percutaneous nephrolithotomy and provide theoretical evidence for clinical treatment.Sixty-eight patients with upper urinary tract stones from September 2008 to December 2009 were involved in this study.They all underwent mini-percutaneous nephrolithotomy. Normal saline was used as irrigation fluid during operation. The mean anaesthesia and irrigation time was 107.0±40.0 min and 70.7±30.1 min separately.The irrigation fluid volume was 23.16±10.79L. The speed of irrigation was between 220 ml-min-1 and 320 ml-min-1 and the pressure of irrigation was 30 kPa.Heart rate (HR), systolic blood pressure, diastolic blood pressure were recorded before irrigation, during irrigating for 10 minutes,30 minutes,60 minutes and after irrigation. Electrolyte, serum creatinine, (BUN), pH and the density of HCO3- were determined before irrigation, during irrigating for 60 minutes and after irrigation. Hemorheology was also determined before irrigation, during irrigating for 60 minutes and after irrigation.During irrigation HR was not significantly different between every two stages(P>0.05). Systolic blood pressure and diastolic blood pressure in stage of T3 was obviously lower than T1 and T2(P<0.05). Na+ and K+ did not change significantly(P>0.05). Ca2+ was significantly decreased in T2 and T3(P<0.05). Cl- was significantly increased after irrigation(P<0.05).When compared with before operation, Cr and BUN were not significantly different between every two stages(P>0.05). pH and HCO3- were significantly decreased in T2 and T3(P<0.05).There was significant decrease of the whole blood viscosity at high, middle and low shear rate, the whole blood reduced viscosity at high and low shear rate, plasma viscosity, the index of RBC deformation, the index of RBC aggregation and the maximum rate of platelet aggregation at T3 and T2 compared with T1(P<0.05).HCT and the index of RBC rigidity were significantly different at T2 from T1(P<0.05). The whole blood viscosity at high shear rate, plasma viscosity,HCT, the index of RBC rigidity and the maximum rate of platelet aggregation were significantly different at T3 from T2(P<0.05).ESR and ESR equation quotient(K) was not significantly different between every two stages(P>0.05).We can reach such conclusions:1.Irrigation fluid's absorption was observed during mini-percutaneous nephrolithotomy irrigated with normal saline. No significant changes were found in hemodynamic,fluid-electrolyte balance and hemorheology for those patients with normal compensation when the amount of fluid was small.2.Some complications such as decreased blood pressure, hypocalcemia, hyperchloraemia, metabolic acidosis and the changed index of hemorheology might take place if extension of operation time and large amount of irrigation fluid's absorption during mini-percutaneous nephrolithotomy.3.The administration of irrigation fluid and the velocity and pressure of irrigation fluid should be strict. The monitoring of related index especially hemodynamic,fluid-electrolyte balance and hemorheology was very important.Corresponding measures should be taken to deal with the matter in time.