不同麻醉方法行经皮肾镜钬激光碎石术的临床观察

目的：观察腰-硬联合麻醉（CSEA）和全凭静脉麻醉（TIVA）下经皮肾镜钬激光碎石术的有效性和安全性。方法：285例患者随机分为CSEA组（n=120）和TIVA组（n=165）。术中监测血压（BP）、心率（HR）、呼吸（R）、血氧饱和度（SpO2）变化及不良反应。结果：CSEA组感觉平面出现为1～3min，阻滞范围T5-10～S5，麻醉后30min血压下降（P〈0．05）。TIVA组术中心率减慢（P〈0．05），麻醉平稳，苏醒期无明显的躁动。结论：CSEA和TIVA均可用于经皮肾镜钬激光碎石手术，对于年龄较大、体形过于肥胖或预计手术时间较长者，以选择TIVA为好。

Comparison of efficacy and safety of different anesthesia for percutaneous holmium laser lithotripsy under nephroscope

Objective：To observe the efficacy and safety of combined spinal epidural anesthesia （CSEA） and total intravenous anaesthesia（TIVA）for percutanous holmium laser lithotripsy under nephroscope. Methods： 285 patients were divided randomly into two groups： CSEA group （n = 120） and TIVA group （n = 165）. The blood pressure （BP）, heart rate （HR）, respiration （R）, pulse oxygen saturation （SpO2） and adverse effect were monitored and recorded during the procedure. Results ： In CSEA group, the onset time of spinal anesthesia was at l to 3 min after CSEA, the block level was maintained at T5-10 - S5, and the BP was decreased 30 min after Spinal block （P 〈 0.05 ）. In TIVA group, the HR was decreased significantly during the operation （P 〈 0.05）, but the anesthesia was quick and steady, without side effect of restlessness. Conclusion： Both CSEA and TIVA can be used for the percutanous holmium laser lithotripsy under nephroscope. However, TIVA is a reliable and effective anaesthesia method, with greater safety and more comfort than CSEA for obesity or elderly patients and longer - time operation.