间歇阶梯式增能方式对体外冲击波碎石后肾损伤保护作用的随机对照研究
|
摘要
目的探讨不同阶梯式增能方式对体外冲击波碎石(ESWL)后肾损伤的保护作用。方法 120例7～15mm单发肾结石患者被随机分为3组:常规组(常规阶梯式增能)、间歇组(间歇阶梯式增能)和缓慢组(缓慢阶梯式增能)。在ESWL前及ESWL后2h、24h、48h、1周和2周分别检测患者的尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和胱抑素C(Cys C)。同时比较ESWL前后视觉模拟疼痛评分(VAS)。2周后统计排净率及并发症率等。结果 3组患者的基线VAS评分及尿NGAL、Cys C值、2周排净率及并发症率均无显著性差异(P>0.05)。间歇组、缓慢组各时点NGAL及Cys C升高幅度显著低于常规组(P<0.001)。缓慢组术后VAS评分显著低于常规组、间歇组(P<0.001)。结论 ESWL治疗肾结石时,间歇阶梯式增能及缓慢阶梯式增能在保持良好的碎石效果的同时均可以起到减轻肾损伤的作用;并且后者的疼痛感更轻,患者接受度更好。
Objective To evaluate the effects of different step-wise ramping protocols on the reduction of renal injury in patients receiving extracorporeal shockwave lithotripsy(ESWL).Methods A total of 120 patients with solitary radiopaque renal stones<15 mm were recruited prospectively and randomized into 3 groups:group A received standard step-wise ramping protocol,group B received step-wise ramping and pause protocols,and group C received slow step-wise ramping protocol.Spot urine samples were collected before treatment,and 2h,24h,48h,1w and 2w after treatment to monitor the levels of neutrophil gelatinase-associated lipocalin(NGAL) and cystatin C(Cys C).Visual analogue pain score(VAS) was collected before and after lithotripsy.Stone-free rate(SFR) and complication rate were compared 2 weeks postoperatively.Results The 3 groups had comparable baseline data(urine NGAL,Cys C,VAS),and the treatment outcomes(SFR,complication rate) were also comparable 2 weeks postoperatively(P>0.05).The increase amplitude of NGAL and Cys C in group B and C(P<0.001) was significantly lower than in group A.The VAS was significantly lower in group C than that in group A and B(P<0.001).Conclusion Step-wise ramping with pause protocols and slow step-wise ramping protocol led to significant decreases in ESWL-induced renal injury with acceptable treatment outcomes.Slow step-wise ramping protocol had higher patient acceptance due to lighter pain feeling.
Objective To evaluate the effects of different step-wise ramping protocols on the reduction of renal injury in patients receiving extracorporeal shockwave lithotripsy(ESWL).Methods A total of 120 patients with solitary radiopaque renal stones<15 mm were recruited prospectively and randomized into 3 groups:group A received standard step-wise ramping protocol,group B received step-wise ramping and pause protocols,and group C received slow step-wise ramping protocol.Spot urine samples were collected before treatment,and 2h,24h,48h,1w and 2w after treatment to monitor the levels of neutrophil gelatinase-associated lipocalin(NGAL) and cystatin C(Cys C).Visual analogue pain score(VAS) was collected before and after lithotripsy.Stone-free rate(SFR) and complication rate were compared 2 weeks postoperatively.Results The 3 groups had comparable baseline data(urine NGAL,Cys C,VAS),and the treatment outcomes(SFR,complication rate) were also comparable 2 weeks postoperatively(P>0.05).The increase amplitude of NGAL and Cys C in group B and C(P<0.001) was significantly lower than in group A.The VAS was significantly lower in group C than that in group A and B(P<0.001).Conclusion Step-wise ramping with pause protocols and slow step-wise ramping protocol led to significant decreases in ESWL-induced renal injury with acceptable treatment outcomes.Slow step-wise ramping protocol had higher patient acceptance due to lighter pain feeling.
引文
[1]那彦群,叶章群,孙颖浩.2014版中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:129-242.
[2]CONNORS BA,EVAN AP,BLOMGREN PM,et al.Effect of initial shock wave voltage on shock wave lithotripsy-induced lesion size during step-wise voltage ramping[J].BJU Int,2009,103(1):104-107.
[3]HANDA RK,MCATEER JA,CONNORS BA,et al.Optimising an escalating shockwave amplitude treatment strategy to protect the kidney from injury during shockwave lithotripsy[J].BJUInt,2012,110(11Pt C):1041-1047.
[4]陶仅德,李秋雨,漆典,等.体外冲击波碎石致肾损伤的磁共振成像及生化指标改变及其临床意义[J].现代泌尿外科杂志,2017,22(2):104-107.
[5]伏旭,岳中瑾.如何提高体外冲击波碎石的成功率[J].现代泌尿外科杂志,2015,20(5):364-366.
[6]张东亮,陈嵘,郭辉,等.不同能量和频率EESWL治疗肾结石的疗效及肾组织损伤的临床研究[J].临床泌尿外科杂志,2018,33(2):110-113.
[7]BHOJANI N,LINGEMAN JE.Shockwave lithotripsy-new concepts and optimizing treatment parameters[J].Urol Clin N Am,2013,40(1):59-66.
[8]SIDDIQI Z,KAROLI R,KAUL A,et al.Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy[J].Ann Afr Med,2017,16(3):101-106.
[9]邓超,王国增,章璟,等.体外冲击波碎石前后肾损伤生化指标的比较[J/OL].中华临床医师杂志,2015,9(2):86-90.
[10]ATAEI N,AMELI S,YOUSEFIFARD M,et al.Urinary neutrophil gelatinase-associated lipocalin(ngal)and cystatin C in early detection of pediatric acute kidney injury;a diagnostic accuracy study[J].Emerg(Tehran),2018,6(1):e2.
[11]WILLIS LR,EVAN AP,CONNORS BA,et al.Prevention of lithotripsy-induced renal injury by pretreating kidneys with lowenergy shock waves[J].J Am Soc Nephrol 2006,17(3):663-673.
[12]LAMBERT EH,WALSH R,MORENO MW,et al.Effect of escalating versus fixed voltage treatment on stone comminution and renal injury during extracorporeal shock wave lithotripsy:aprospective randomized trial[J].J Urol,2010,183(2):580-584.
[13]NG CF,LUKE S,YEE CH,et al.A prospective randomized study comparing the effect of different kidney protection treatment protocols on acute renal injury after extracorporeal shockwave lithotripsy[J].J Endourol,2017,31(1):57-65.
[14]NG CF,LUKE S,YEE CH,et al.Extracorporeal shockwave lithotripsy could lead to a prolonged increase in renal fibrotic process of up to 2years[J].J Endourol,2018,32(3):223-229.
[15]HANDA RK,BAILEY MR,PAUN M,et al.Pretreatment with low-energy shock waves induces renal vasoconstriction during standard shock wave lithotripsy(ESWL):a treatment protocol known to reduce ESWL-induced renal injury[J].J Urol,2008,103:1270-1274.
[2]CONNORS BA,EVAN AP,BLOMGREN PM,et al.Effect of initial shock wave voltage on shock wave lithotripsy-induced lesion size during step-wise voltage ramping[J].BJU Int,2009,103(1):104-107.
[3]HANDA RK,MCATEER JA,CONNORS BA,et al.Optimising an escalating shockwave amplitude treatment strategy to protect the kidney from injury during shockwave lithotripsy[J].BJUInt,2012,110(11Pt C):1041-1047.
[4]陶仅德,李秋雨,漆典,等.体外冲击波碎石致肾损伤的磁共振成像及生化指标改变及其临床意义[J].现代泌尿外科杂志,2017,22(2):104-107.
[5]伏旭,岳中瑾.如何提高体外冲击波碎石的成功率[J].现代泌尿外科杂志,2015,20(5):364-366.
[6]张东亮,陈嵘,郭辉,等.不同能量和频率EESWL治疗肾结石的疗效及肾组织损伤的临床研究[J].临床泌尿外科杂志,2018,33(2):110-113.
[7]BHOJANI N,LINGEMAN JE.Shockwave lithotripsy-new concepts and optimizing treatment parameters[J].Urol Clin N Am,2013,40(1):59-66.
[8]SIDDIQI Z,KAROLI R,KAUL A,et al.Evaluation of neutrophil gelatinase-associated lipocalin and cystatin C as early markers of diabetic nephropathy[J].Ann Afr Med,2017,16(3):101-106.
[9]邓超,王国增,章璟,等.体外冲击波碎石前后肾损伤生化指标的比较[J/OL].中华临床医师杂志,2015,9(2):86-90.
[10]ATAEI N,AMELI S,YOUSEFIFARD M,et al.Urinary neutrophil gelatinase-associated lipocalin(ngal)and cystatin C in early detection of pediatric acute kidney injury;a diagnostic accuracy study[J].Emerg(Tehran),2018,6(1):e2.
[11]WILLIS LR,EVAN AP,CONNORS BA,et al.Prevention of lithotripsy-induced renal injury by pretreating kidneys with lowenergy shock waves[J].J Am Soc Nephrol 2006,17(3):663-673.
[12]LAMBERT EH,WALSH R,MORENO MW,et al.Effect of escalating versus fixed voltage treatment on stone comminution and renal injury during extracorporeal shock wave lithotripsy:aprospective randomized trial[J].J Urol,2010,183(2):580-584.
[13]NG CF,LUKE S,YEE CH,et al.A prospective randomized study comparing the effect of different kidney protection treatment protocols on acute renal injury after extracorporeal shockwave lithotripsy[J].J Endourol,2017,31(1):57-65.
[14]NG CF,LUKE S,YEE CH,et al.Extracorporeal shockwave lithotripsy could lead to a prolonged increase in renal fibrotic process of up to 2years[J].J Endourol,2018,32(3):223-229.
[15]HANDA RK,BAILEY MR,PAUN M,et al.Pretreatment with low-energy shock waves induces renal vasoconstriction during standard shock wave lithotripsy(ESWL):a treatment protocol known to reduce ESWL-induced renal injury[J].J Urol,2008,103:1270-1274.