Jung Helene U, Jakobsen Joern S, Frimodt-Moeller Poul C, Osther Palle J S
Department of Urology, Fredericia Hospitals, Fredericia, Denmark.
Scand J Urol Nephrol. 2008;42(2):158-63. doi: 10.1080/00365590701570631.
Ureterorenoscopy causes complications that may be related to high intrarenal pressures generated during irrigation. Endoluminal isoproterenol administration has been shown to reduce pelvic pressure in pigs. The objective of this study was to investigate possible systemic side-effects of isoproterenol irrigation during ureterorenoscopy in humans.
Seven patients undergoing ureterorenoscopy due to renal stone disease were included. A 5-Fr catheter was retrogradely placed in the renal pelvis for pressure measurements. Prior to irrigation with isoproterenol (0.1 microg/ml), ureterorenoscopy was performed with saline irrigation. Renal pelvic pressure, blood pressure and heart rate were measured before and after isoproterenol irrigation. Venous blood was drawn for isoproterenol measurements.
Endoluminal isoproterenol irrigation produced no changes in mean heart rate (HR) or mean arterial pressure (MAP). MAP (+/- SEM) was 56 (2.7) mmHg during saline irrigation and 58 (+/- 2.4) mmHg during isoproterenol irrigation. HR was 60 (+/- 4) beats/min before and 61 (+/- 4) beats/min during isoproterenol irrigation. Neither the difference in MAP = 0.10) nor the difference in HR (p = 0.23) were significant. Pelvic pressure was significantly lower during isoproterenol irrigation [19 (+/- 3) mmHg] compared to saline irrigation [35 (+/- 2.6) mmHg] (p = 0.0006). Pelvic pressure reached very high levels (> 300 mmHg), especially during injection of contrast medium.
Endoluminal isoproterenol irrigation during ureterorenoscopy causes no cardiovascular side-effects and the drug may reduce renal pelvic pressure.
输尿管肾镜检查会引发一些并发症，这些并发症可能与冲洗过程中产生的高肾内压力有关。已证实向猪体内腔内注射异丙肾上腺素可降低肾盂压力。本研究的目的是调查在人体输尿管肾镜检查期间异丙肾上腺素冲洗可能产生的全身副作用。
纳入7例因肾结石疾病接受输尿管肾镜检查的患者。将一根5F导管逆行置入肾盂以测量压力。在用异丙肾上腺素（0.1微克/毫升）冲洗之前，先用生理盐水进行输尿管肾镜检查。在异丙肾上腺素冲洗前后测量肾盂压力、血压和心率。采集静脉血以测量异丙肾上腺素水平。
腔内异丙肾上腺素冲洗后平均心率（HR）或平均动脉压（MAP）无变化。生理盐水冲洗期间MAP（±标准误）为56（2.7）毫米汞柱，异丙肾上腺素冲洗期间为58（±2.4）毫米汞柱。异丙肾上腺素冲洗前HR为60（±4）次/分钟，冲洗期间为61（±4）次/分钟。MAP的差异（p = 0.10）和HR的差异（p = 0.23）均无统计学意义。与生理盐水冲洗[35（±2.6）毫米汞柱]相比，异丙肾上腺素冲洗期间肾盂压力显著降低[19（±3）毫米汞柱]（p = 0.0006）。肾盂压力达到非常高的水平（>300毫米汞柱），尤其是在注射造影剂期间。
输尿管肾镜检查期间腔内异丙肾上腺素冲洗不会引起心血管副作用，且该药物可能降低肾盂压力。
