输尿管镜气压弹道碎石术患者双间隙腰-硬联合阻滞的效应

目的 观察双间隙腰-硬联合麻用于输尿管镜气压弹道碎石术的麻醉效果.方法 选择行输尿管镜下气压弹道碎石术患者160例,随机分成单间隙组和双间隙两组,每组80例.单间隙组（SG组）：只选L3-4间隙行腰-硬联合阻滞术,往蛛网膜下腔向头侧注入0.75%布比卡因2ml＋10%葡萄糖1ml,共3ml,注药的速度为0.5ml/s.并常规向头侧置入硬外导管3cm.双间隙组（DG组）：先选T11～12行硬脊膜外穿刺成功后向头侧置入硬外导管3cm.后选L3～4间隙行腰-硬联合麻,向尾侧置入硬膜外导管3cm.腰麻用药、平面调节情况同SG组.在腰麻用药15分钟后,上管开始用药,根据腰麻的平面或定时追加局麻药,使上界麻醉的平面维持在T4以下.两组病人从腰麻用药30分钟起,每隔15分钟统计麻醉效果一次.结果 在105分钟内完成的手术,两组麻醉效果优良率无显著差异（P＞0.05）;随着手术时间的延长,DG组麻醉效果优良率高于SG组（P＜0.05）.结论 双间隙腰-硬联合麻醉能为输尿管镜气压弹道碎石术提供优良的麻醉效果,且不受手术时间的影响.

Effect of double space spinal-epidural anesthesia on lithotripsy with ureterscope

Objective To discuss the proper anesthesia method for lithotripsy with ureterscope. Methods 160 patients who had suffered from ureterolithiasis were divided randomly into SG group and DG group. Group SG(n=80): Spinal puncture was performed only at L3~4 interspace. A total amount of 0.75% bupivacaine 2ml with 10% glucose 1 ml was infused to spinal . A catheter was inserted 3cm in the epidural space. If clinical efficacy was inadequate 2% Lidocaine was given epidural. Group DG(n=80): Epidural puncture was performed at T11~12 interspace first, a catheter was inserted 3cm in the epidural space toward head side . Spinal-epidural puncture was performed at L3~4 interspace. The spinal anesthetic was same as group SG was infused to spinal and a catheter was inserted 3cm in the epidural space toward tail side . After fifteen minutes 2% Lidocaine 3ml was given epidural from up catheter. After five minutes local anesthetic 8~12ml was infused quickly. The medicine was given periodically . The level of anesthesia was below T4. Results In the group DG the anesthetic effect was higher than the group SG (P<0.05). Conclusion Double space spinal-epidural anesthesia is reasonable choice for lithotripsy with ureterscope.