| PartⅠObjective: To analyze the effect of different rehydration methods on the degree of ESWL renal injury in rabbits.To analyze the possibility of reducing ESWL induced renal injury by changing the level of renal perfusion.Methods: Pre experiment: Ten healthy male New Zealand white rabbits aged from 7 to 9 months were used.The peak values of PSV and EDV of renal artery and corresponding time period were monitored by color Doppler ultrasound after(15 / 30)ml / kg graded rehydration.Then 60 healthy male rabbits were randomly divided into fasting group,rehydration group and rehydration diuretic group,with 20 rabbits in each group.In fasting group,water was fasted 12 hours before operation.In rehydration group,30 ml / kg of 0.9% normal saline was injected at the rate of 10 ml / min before operation.In rehydration diuretic group,besides 30 ml / kg of normal saline at the same rate,2.5ml/kg of 20% mannitol was injected at the same time.Since the end of rehydration,the renal artery PSV and EDV were detected by color Doppler ultrasound,and the peak value and corresponding time period were recorded.The changes of rehydration,renal function,plasma EF-1,Cys-C and SOD were compared among the three groups 3 and 7 days after operation.Seven days after ESWL,the right kidneys of rabbits were taken to observe the pathological changes.Results:(1)There was no peak change of PSV and EDV in renal artery from the end of the first rehydration to 60 minutes after the end of rehydration in the animal pre experiment,but the PSV and EDV in renal artery increased from 30 minutes after the completion of the second rehydration,and reached the peak at 60 minutes(P < 0.05);the PSV and EDV in renal artery increased significantly at 30 minutes,45 minutes and 60 minutes after the second rehydration compared with the first rehydration(P < 0.05).(2)Comparison of PSV and EDV of renal artery among three groups: there was no peak change of PSV and EDV of renal artery in fasting group;PSV and EDV of renal artery in rehydration group and rehydration diuretic group increased from 30 min after rehydration and reached the peak at 60min(P < 0.05);PSV and EDV of renal artery in rehydration diuretic group increased significantly compared with rehydration group and fasting group at 30 min,45min and 60min(P < 0.05).(3)There was no significant difference in Cys-C,serum creatinine,plasma EF-1 and SOD among the three groups before operation(P > 0.05).The indexes of Cys-C,serum creatinine and plasma EF-1 of the three groups after shock wave shock were higher than those before shock wave shock on the 3rd and 7th day after operation(P < 0.05),and there was significant difference in Cys-C between the three groups on the 3rd and 7th day after operation(P < 0.05).There was no significant difference in serum creatinine(P > 0.05).The plasma ET-1 levels on the 3rd and 7th day after operation were higher than those before shock wave,and the differences were statistically significant(P < 0.05).The plasma ET-1 levels in the rehydration diuretic group on the 3rd and 7th day after shock wave were significantly lower than those in the fasting and rehydration groups,and the differences were statistically significant(P < 0.05).On the 3rd and 7th day after operation,the level of SOD was lower than that before shock wave.On the 3rd day after operation,there was no difference between rehydration group and rehydration diuretic group(P > 0.05),but there were differences compared with fasting group(P < 0.05).On the 7th day after operation,the level of SOD in rehydration diuretic group was significantly higher than that in fasting and rehydration group(4)The pathological score of fasting group was higher than that of rehydration and diuresis group(P < 0.05),but there was no significant difference between fasting group and rehydration group(P > 0.05).Conclusion:(1)The renal artery blood flow PSV and EDV of the three groups were compared and analyzed.The results showed that increasing the amount of fluid infusion and fluid infusion combined with diuretics could significantly affect the renal perfusion of rabbits.(2)Through the statistical analysis of renal function,plasma ET-1 and SOD test indexes and pathomorphological changes of three groups of rabbits,it shows that increasing renal blood perfusion can effectively protect the kidney injury after extracorporeal shock wave lithotripsy.PartⅡObjective: To study the effect of routine preoperative fluid replacement and diuresis on renal injury and lithotripsy.Methods: 90 patients with renal calculi who underwent ESWL in our hospital were randomly divided into fasting group,rehydration group and rehydration diuretic group,30 cases in each group.In the group of rehydration and diuresis,1000 ml 0.9% normal saline was infused.At the same time,20% mannitol 250 ml was given.The rehydration time was controlled within 2 hours,and the mannitol infusion was controlled within 30 minutes.Renal function,N-acetyl-β-D-glucosidase(NAG),β 2-microglobulin(β 2-mg)and clinical symptoms such as postoperative calculus,renal colic,hematuria were compared among the three groups.Results:(1)there was no significant difference in the preoperative renal function(Cys-C,serum creatinine),urinary NAG and β 2-mg among the three groups(P > 0.05);the renal function,urinary NAG and serum β 2-mg on the 3rd day after operation were higher than those before ESWL,and the changes of Cys-C in fasting group were more significant than those in other treatment groups(P < 0.05);the renal function indexes of each group decreased in varying degrees on the 7th day after operation There was no significant difference between the two groups(P > 0.05),but the Cys-C sensitive index was more obvious,and there was no significant difference in serum creatinine(P > 0.05).(2)There was no significant difference in preoperative urinary NAG and β 2-mg among the three groups(P > 0.05).The urinary NAG and β 2-mg indexes of the three groups after lithotripsy were higher than those before lithotripsy on the 3rd day after operation(P < 0.05).The urinary NAG and β 2-mg indexes of the three groups decreased in different degrees on the 7th day after operation,and there was no significant difference between the groups(P > 0.05),The urinary NAG and β 2-mg levels in the rehydration and diuresis group were lower than those in the fasting and rehydration groups 3 and 7 days after operation(P < 0.05),but there was no significant difference in the urinary NAG and β 2-mg levels between the fasting and rehydration groups(P > 0.05).(3)According to the follow-up and postoperative kub or CT scan of urinary system,the one-time lithotripsy effective rate(93.3%),the number of postoperative renal colic(1.1 ± 1.3)and the incidence of postoperative hematuria(43.7%)in the rehydration and diuresis group were better than those in the fasting group and the rehydration group,the results were statistically significant(P < 0.05),and there was no significant difference between the rehydration group and the fasting group(P>0.05)。Conclusion:(1)Appropriate fluid replacement and diuresis before ESWL play a certain role in early protection of renal injury in patients with ESWL,and the long-term effect needs further study.(2)Appropriate fluid replacement and diuresis before ESWL can improve the efficiency of lithotripsy and reduce the postoperative complications. |
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