不同麻醉方法下输尿管镜钬激光碎石术治疗输尿管上段结石的比较

目的：观察比较腰麻-硬膜外联合麻醉（CSEA）和喉罩通气全麻用于输尿管上段结石钬激光碎石术的有效性和安全性。方法：输尿管上段结石患者192例，随机分为两组，分别采用CSEA和喉罩通气全麻，均行输尿管镜下钬激光碎石术治疗。比较两组患者术中血压、心率变化以及手术时间、手术操作难易程度、结石返回肾脏发生率和术中患者不适程度。结果：麻醉后及术中，CSEA组有明显血压下降和心率增加（P〈0．05），喉罩通气全麻组无明显变化；喉罩通气全麻组无明显体动，呼吸控制良好，易于碎石手术操作，患者无不适反应，结石返回肾脏发生率低于CSEA组。结论：对于输尿管上段结石，钬激光碎石术、喉罩通气全麻比CSEA更安全和舒适，更有利于手术操作、缩短手术时间和提高碎石成功率。

Comparison of different anesthesia methods for ureteroscopic lithotripsy with the holmium laser for upper ureteral calculi

Objective:To estimate the efficacy and safety of combined spinal epidural anesthesia(CSEA) or general intravenous anaesthesia with laryngeal mask airway(LMA) when performing ureteroscopic lithotripsy using the holmium laser for upper ureteral calculi.Methods:Before ureteroscopic lithotripsy using the holmium laser,patients(n=192) with upper ureteral calculi received either CSEA or general intravenous anaesthesia with LMA(n=96,respectively).Changes of blood pressure and heart rates during the operation as well as the rate of success of lithotipsy,patients' sense of comfort,operative side-effects and difficulty were noted and compared in the two groups.Results:During the operation,a significant fluctuation of circulation was observed in the CSEA group(P<0.05) while the patients in the LMA group had stable circulation with fewer operative side-effects,lower operative difficulty and a higher rate of success than those in the CSEA group.Conclusions:Ureteroscopic lithotripsy using the holmium laser is an effective therapeutic method for upper ureteral calculi,and general intravenous anaesthesia with LMA is a reliable and effective anaesthesia method with greater safety and more comfort than CSEA for this operation.