不同麻醉方式下经皮肾穿刺碎石术的临床观察

目的 比较全身麻醉与椎管内麻醉下经皮肾穿刺碎石术(PCNL)患者循环、呼吸、体温的变化以及麻醉恢复期相关并发症的发生情况,以评价麻醉效果与安全性.方法 ASA分级Ⅰ～Ⅱ级择期行PCNL患者40例,按随机数字表法分为气管内插管全身麻醉组(Ⅰ组)和椎管内麻醉组(Ⅱ组),每组20例.记录两组患者的体温、心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)的变化及恢复期不良反应发生情况.结果 Ⅰ组麻醉过程平稳,各时间点MAP、心率无明显变化;Ⅱ组麻醉效果确切,但麻醉后15 min的MAP及截石位后、俯卧位后的心率和MAP均较麻醉前和Ⅰ组有明显变化(P＜0.05).两组患者麻醉后30、60、90、120min的体温均较麻醉即刻有不同程度的下降(P＜0.05),且Ⅰ组患者麻醉后30、60min体温[(35.8±0.6)、(34.8±0.5)℃]明显低于Ⅱ组[(36.2±0.6)、(35.6±0.5)℃](P＜0.05).两组患者麻醉恢复期寒战、恶心、咽痛、背部不适均有发生,其中以发生寒战者最多.结论 两种麻醉方式均适用于PCNL;椎管内麻醉下术中需严密观察患者的各项生命指标;而对于肥胖、体质较弱、呼吸循环代偿功能较差的患者宜选用气管内插管全身麻醉.

Abstract：

Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.

Clinical observation of different ways of anesthesia in patients undergoing percutaneous nephrolithotomy

Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.