Experimental And Cliniced Study On The Renal Awerse Effect Of Flushing Into Pelvis

Objective:To study the different perfusion pressures on the health of different reperfusion time after reperfusion in rabbits with unilateral renal pelvis and sustained, effects on kidney structure, and the choice of percutaneous nephrolithotomy stone surgery patients to compare different reperfusion time on kidney infection, kidney infection-free renal function, and thus for clinical percutaneous renal surgery in choosing the right perfusion pressure, perfusion time, provide a basis for avoiding or reducing damage to the kidneys during surgery.Method:1. animals in experimental group: 80 healthy rabbits as experimental animals were randomly divided into 10 groups (n = 8). According to perfusion pressure, perfusion duration can be divided into: A group: for renal biopsy, but not to reperfusion; B group: perfusion pressure 50cmH₂O, reperfusion time 30min; C group: perfusion pressure 50cmH₂O, reperfusion time 45min; D Group: perfusion pressure 50cmH₂O, perfusion time, 60min; E group: perfusion pressure 100cmH₂O, perfusion time, 30min; F group: perfusion pressure 100cmH₂O, perfusion time, 45min; G Group: perfusion pressure 100cmH₂O, perfusion time, 60min; H Group: perfusion pressure 120cmH₂O, perfusion time of 30min; I group: perfusion pressure 120cmH₂O, reperfusion time 45min; J group perfusion pressure 120cmH₂O, reperfusion time 60min 10 groups. Using normal saline as the perfusion fluid, intraoperative perirenal effusion in mind that there are (+), no perirenal effusion in mind (-). Removed after 12 hours to do rabbit kidney biopsy, biopsy under the microscope in each of the five high power field, counting them there tubular casts, there are epithelial cell swelling in mind (+), non-epithelial cell swelling in mind ( -), compare different groups of renal structure. 2. Clinical observation group: 64 cases of surgery were selected, divided into 8 groups, according to infection, infusion time can be divided into: group 1 infection, <30min; 2 group infection, <60min; 3 group infection, <90min; 4 groups infection,≤120min; 5 was no infection, <30min; 6 was no infection, <60min; 7 was no infection, <90min; 8 was no infection,≤120min8 groups. Perfusion, respectively, before perfusion after 2 hours, 24 hours, 3 days, 7 days Urine samples were compared using repeated measures analysis of variance in each groupβ2-MG, NAG changes.Results:1.Animal experiments:1.1.Comparison of different perfusion pressure: the pressure in the perfusion experiments leakage rate Renal Week, by using the exact test: P = 0.00, among all groups that the perirenal effusion was significantly more leakage rate. Perfusion pressure of 50 cmH₂O group and 100 cmH₂O perfusion pressure compared withχ² segmentation test:χ² = 42.02 P = 0.00 p <0.05, that the perfusion pressure of 100 cmH₂O group exudation was high.Perfusion pressure of 50 cmH₂O group and 120 cmH₂O perfusion pressure compared withχ² test section method:χ² = 38.19 P = 0.00 p <0.05, that the perfusion pressure of 120 cmH₂O group higher leakage rate.Perfusion pressure of 100 cmH₂O group and 120 cmH₂O perfusion pressure compared withχ² test section method:χ² = 30.25P = 0.00 p <0.05, that the perfusion pressure of 120 cmH₂O group higher leakage rate.Reperfusion renal biopsy in the protein casts count random design analysis of variance showed that: the R group and the normal group, P <0.05, reperfusion injury significantly. The main effect of stress F = 35.248, P = 0.00.1.2 Comparison of different reperfusion time: perfusion renal biopsy protein casts count random design analysis of variance showed that: the R group and the normal group, P <0.05. Time main effect F = 11.621, P = 0.22,.1.3 The naked eye: perfusion pressure 50cmH₂O, the 24 patients, 6 patients had significant renal perfusion fluid extravasation week; perfusion pressure 100cmH2O, 24 cases, 12 patients had significant perirenal extravasation of infusion fluid; perfusion pressure 50cmH2O, the 24 patients, 17 patients had significant perirenal extravasation of infusion fluid.2 Clinical observations:2.1 No infection:2.1.1β₂-MG in each group content analysis of variance with repeated measures test showed that: perfusion pressure was within time for 90min, F = 2.56 P = 0.09 P> 0.05, can be considered statistically significant. Perfusion pressure for more than 90min, the first 3 days, F = 41.2 P = 0.00, P <0.05, perfusion of the kidney injury was, but three days later, F = 1.67 P = 0.24, P> 0.05, no statistical significance can be considered .2.1.2 NAG levels in each group using repeated measures analysis of variance test results: time of perfusion pressure was within 90min, F = 2.94 P = 0.12 P> 0.05, can be considered statistically significant. Perfusion pressure for more than 90min, the first 3 days, F = 36.7 P = 0.00, P <0.05, perfusion of the kidney damage was significant, but three days later, F = 1.87 P = 0.22, P> 0.05, can be considered no statistical significance. 2.2 Infection:2. 2.1β2-MG in each group content analysis of variance with repeated measures test showed that: perfusion pressure was within time for 60min, F = 2.84 P = 0.11, P> 0.05 can be considered statistically significant. Perfusion pressure after more than 60min when, F = 46.5 P = 0.00, P <0.05, reperfusion injury of the kidneys was statistically significant.2.2.2 NAG levels in each group using repeated measures analysis of variance test results: time of perfusion pressure was within 60min, F = 3.01 P = 0.09, P> 0.05 can be considered statistically significant. Perfusion pressure after more than 60min when, F = 48.1 P = 0.00, P <0.05, reperfusion injury of the kidneys was statistically significant.2.2.3 Infection group and non-infectedβ₂-MG levels between groups comparison, t test, t = 2.06, p = 0.04,α= 0.05 according to test standards that the infection group and non-infection group were statistically compared between the NAG content significance of infection-prone than non-infected group reperfusion renal injury.2.2.4 The infected group and non-infected group was used to compare between the NAG content of t test, t = 3.75, p = 0.00,α= 0.05 according to test standards that the infection and no infection between the groups was statistically significant compared NAG levels, infection-prone than non-infected group reperfusion renal injury.Conclusion:1. Rabbit renal pelvis perfusion pressure for experimental> 50cmH2O, perfusion time> 30min or more, the pathological swelling of epithelial cells are visible.2. Pelvis perfusion pressure can cause glomerular and tubular damage.3. The same perfusion pressure, perfusion longer found in rabbit renal biopsy protein casts more.4. The same reperfusion time, the perfusion pressure greater perfusion renal perfusion solution the greater the leakage rate, renal biopsy found in protein casts more.5. Percutaneous nephrolithotomy for patients lithotomy, the infusion time of> 90min, increasing the possibility of reperfusion renal injury.6. Clinical percutaneous nephrolithotomy stone surgery in the same perfusion pressure, kidney infection before surgery than non-infected person vulnerable to kidney damage; kidney are infected, the best time to control the infusion within 60min.