Objective To evaluate the clinical efficacy of ultrasound-guided percutaneous pneumatic nephrolithotomy combined with ultrasonic lithotripsy in the treatment of renal calculi.Methods Fifty-nine patients with complicated renal calculi(ranged from 2.8 to 7.0 cm in diameter measured by KUB),including 36 patients with unilateral calculi and 23 patients with bilateral calculi,received percutaneous nephrolithotomy by using ultrasonic and pneumatic lithotripter(EMS Ⅲ),puncture hard wire,and mental dilator.A track from the skin surface into the kidney was established under the guidance of B ultrasonography.Results 82 tracks in the 59 patients were successfully established.The mean operation time was 90 minutes(45-150 minutes),and the management time of stones was 30-70 minutes.Residual stones were found in 15 kidneys and were removed by extracorporeal lithotripsy or two stage lithotripsy two weeks after operation.The clearance rate of stone in one session and two sessions was 82%(67/82) and 93%(14/15),respectively.Hospital stay was 5-15 days(mean,10 days).A follow-up of 1-6 months(mean,3.2 months) in 59 cases showed no severe bleeding,infections,and stone recurrence.Conclusions Ultrasound-guided percutaneous pneumatic nephrolithotomy combined with ultrasonic lithotripsy for complicated renal calculi is characterized by high efficiency,safety and minimal invasion.

Objective To analyze the effects of different age and gender on the efficacy and pharmacokinetics of the target controlled infusion of atracurium besylate on liver dysfunction.Methods 160 case of patients with liver dysfunction and undergoing elective general anesthesia operation were divided into four groups according to their age and gender, 40 cases in each group:group A (age≥65 years old, male), group B (age≥65 years old, female), group C (age<65 years old, male), group D (age<65 years old, female).The patients received one-time double dose ED95 atracurium besylate, pharmacodynamic indexes and pharmacokinetic parameters were compared.Results The four groups of patients with block onset time, block maintenance time, clinical duration of T25%, in vivo role time T95%, muscle relaxation recovery index were compared, the difference was not statistically significant.The preoperative and postoperative 24h, four groups of patients with liver function ( alanine aminotransferase, aspartate aminotransferase, albumin, bilirubin) and renal function ( creatinine, urea nitrogen) were compared, the difference was not statistically significant.There was no significant difference between the four groups in the plasma concentrations of the substance to be measured, the peak time, the area under the curve and the elimination half lives.Conclusion For the patients with liver dysfunction, the target controlled infusion of atracurium besylate in general anesthesia operation, gender and age were not considered.