经皮肾镜碎石手术不同麻醉方法的临床分析

目的探讨腰麻-硬膜外联合麻醉(CSEA)与全麻用于经皮肾镜碎石取石术(PCNL)的优劣。方法 120例经皮肾镜碎石取石术的患者随机分为腰麻-硬膜外麻醉(CSEA)组和全麻组,每组各60例。连续监测两组患者血压(MBP)、心率(HR)、血氧饱和度(SpO2)、分别于麻醉前(T0)、截石位(T1)、仰斜位(T2)、术中1 h(T3)、术中2 h(T4)及术毕(T5)记录各组数据,记录两组病人术后完全清醒时间、镇痛效果以及不良反应。结果两组各时间点的血压(MBP)、心率(HR)、血氧饱和度(SpO2)差异无统计学意义,镇痛效果无显著性差异,全麻组出现6例体温低并术后苏醒延迟,CSEA组在手术3 h后有2例患者主诉全身疲乏,难以忍受肾区的显露。结论在患者状态好、准备充分的情况下,腰麻-硬膜外麻醉(CSEA)可以做为经皮肾镜碎石取石术(PCNL)首选,患者条件差,预计手术时间长则选择全麻。

CLINICAL ANALYSIS OF DIFFERENT METHOD OF ANESTHESIA IN THE PERCUTANEOUS RENAL LITHOTRIPSY

Objective To compare the advantage and disadvantage of the combined spinal - epidural anes- thesia （CSEA） and general anesthesia that are used in the percutaneous renal lithotripsy （PCNL）. Methods 120 pa- tients of percntaneous renal lithotripsy were randomly divided into combined spinal -epidural anesthesia（CSEA） and the general anesthesia groups, 60 patients in each group. We continuously monitored the patients＇ BP, HR, SpO2 at the time of anesthesia （T0）, the lithotomy position （T~）, Slant （T2 ）, intraoperative 1H （T3 ）, intraoperative 2H （ T4 ） and the end of surgery （ T5 ） and write down the data. Then write down the time of the patients＇ getting fully a- wake, analgesic effects and adverse reactions. Results There are not significant different between the two groups at each time point, MAP, HR, and SpO2, the effect of the analgesic effect has not significant difference. Six patients in the general anesthesia group appeared low body temperature and postoperative recovery delay. In CSEA group, two cases of patients complained of systemic fatigue unbearable exposure of the kidney area three hours after surgery. Con- clusion Patients should preferred to take percutaneous lithotripsy（PCNL） in the combined spinal - epidural anesthe- sia（CSEA） as the first choice at his good time, but for patient with bad condition and operation will take longer time the general anesthesia will be selected.