标题：基于ERAS理念的MPCNL手术对上尿路结石患者术后恢复及氧化应激状况的影响

      作者：谭益元 1，黄金妹 1，黄道礼 2，余文华 1，熊莽 1，黄婷 3    韶关市第一人民医院泌尿外科 1、麻醉科 2、手术室 3，广东 韶关 512000

      卷次： 2024年35卷4期

      【摘要】 目的 探讨基于加速康复外科(ERAS)理念的无管化超微经皮肾镜碎石(MPCNL)手术对上尿路结石患者术后恢复及氧化应激状况的影响。方法 选择2021年1月至2022年6月韶关市第一人民医院收治的120例上尿路结石患者作为研究对象，依据随机数表法将患者分为研究组和对照组各60例。对照组患者采用MPCNL手术联合常规康复模式干预，研究组患者行基于ERAS理念的MPCNL手术。比较两组患者的术后 24 h视觉模拟评分法(VAS)评分、下床活动时间、血尿转清时间、术中出血量、手术时间、术前与术后 24 h应激反应[包括皮质醇(Cor)、前列腺素E2 (PGE2)、促肾上腺皮质激素释放激素(CRH)]以及出院时的并发症发生率。结果 研究组患者的术后 24 h VAS评分、下床活动时间、血尿转清时间、术中出血量及手术时间分别为(2.69±0.50)分、(1.24±0.16) d、(2.43±0.25) d、(72.31±14.60) mL、(47.84±2.36) h，明显低(短)于对照组的(3.77±0.63)分、(2.20±0.19) d、(3.23±0.32) d、(84.95±16.38) mL、(55.38±3.25) h，差异均有统计学意义(P<0.05)；术前两组患者的Cor、PGE2、CRH水平比较差异均无统计学意义(P>0.05)；术后 24 h，两组患者的Cor、PGE2、CRH水平均高于术前，但研究组患者的Cor、PGE2、CRH水平分别为(139.05±12.31) ng/L、(270.36±20.57) pg/mL、(25.84±5.31) ng/mL，明显低于对照组的(148.34±13.27) ng/L、(297.35±22.14) pg/mL、(29.93±4.72) ng/mL，差异均有统计学意义(P<0.05)；研究组患者出院时的并发症发生率为 5.00%，明显低于对照组的 18.33%，差异有统计学意义(P<0.05)。结论 基于 ERAS理念的MPCNL手术在上尿路结石中应用可促进患者术后恢复、改善氧化应激状况，同时还能减少并发症发生率，值得推广应用。
      【关键词】 上尿路结石；无管化超微经皮肾镜碎石术；加速康复理念；应激反应；恢复时间；并发症
      【中图分类号】 R691.4 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0503—05

Effects of minimally invasive percutaneous nephrolithotripsy surgery based on enhanced recovery after surgeryon postoperative recovery and oxidative stress in patients with upper urinary tract stones.
TAN Yi-yuan 1, HUANGJin-mei 1, HUANG Dao-li 2, YU Wen-hua 1, XIONG Mang 1, HUANG Ting 3. Department of Urology 1, Department ofAnesthesiology 2, Operating Room 3, Shaoguan First People's Hospital, Shaoguan 512000, Guangdong, CHINA
【Abstract】 Objective To explore the impact of minimally invasive percutaneous nephrolithotripsy (MPCNL)based on enhanced recovery after surgery (ERAS) on postoperative recovery and oxidative stress status in patients withupper urinary tract stones. Methods A total of 120 patients with upper urinary tract stones admitted to Shaoguan FirstPeople's Hospital from January 2021 to June 2022 were selected as the research subjects. According to the random num-ber table method, the patients were divided into a study group and a control group, with 60 cases in each group. The pa-tients in the control group underwent MPCNL combined with conventional rehabilitation intervention, while the patientsin the study group underwent MPCNL based on the ERAS concept. The postoperative 24-hour Visual Analogue Scale(VAS) scores, out-of-bed activity time, time to clear hematuria, intraoperative blood loss, surgical time, preoperative andpostoperative 24 h stress responses [including cortisol (Cor), prostaglandin E2 (PGE2), adrenocorticotropin-releasinghormone (CRH)], and incidence of complications at discharge were compared between the two groups. Results Thepostoperative 24 h VAS score, out-of-bed activity time, time to clear hematuria, intraoperative blood loss, and surgicaltime of the study group were (2.69±0.50) points, (1.24±0.16) d, (2.43±0.25) d, (72.31±14.60) mL, and (47.84±2.36) h,respectively, which were significantly lower (shorter) than (3.77±0.63) points, (2.20±0.19) d, (3.23±0.32) d, (84.95±16.38) mL, and (55.38±3.25) h in the control group (P<0.05). There was no statistically significant difference in the lev-els of Cor, PGE2, and CRH between the two groups of patients before surgery (P>0.05); 24 hours after surgery, the lev-els of Cor, PGE2, and CRH in both groups of patients were significantly higher than those before surgery; the levels ofin the study group were (139.05±12.31) ng/L, (270.36±20.57) pg/mL, and (25.84±5.31) ng/mL, respectively, significant-ly lower than (148.34±13.27) ng/L, (297.35±22.14) pg/mL, and (29.93±4.72) ng/mL in the control group; the differenceswere statistically significant (P<0.05). The incidence of complications in the study group at discharge was 5.00%, signifi-cantly lower than 18.33% in the control group (P<0.05). Conclusion The application of MPCNL surgery based onERAS concept in upper urinary tract stones can promote postoperative recovery, improve oxidative stress status, and re-duce the incidence of complications, which is worthy of promotion and application.
      【Key words】 Upper urinary tract stones; Minimally invasive percutaneous nephrolithotripsy; Enhanced recoveryafter surgery; Stress response; Recovery time; Complications