超声引导下椎旁神经阻滞麻醉在经皮肾镜碎石术中的应用

Application of ultrasound guided paravertebral block anesthesia in percutaneous nephrolithotomy

目的探讨超声引导下椎旁神经阻滞麻醉(paravertebralblock,PVB)在微创经皮肾镜取石术(percutaneousnephrolithotomy,PCNL)中应用的可行性、安全性和临床应用效果。方法2019年3月~2020年12月我院收治的上尿路结石病人45例,均接受PCNL手术。通过视觉模拟疼痛量表(visualanalogpainscale,VAS)问卷调查记录病人建立碎石通道后、术后6小时和术后24小时的疼痛评分,记录术后镇痛药物的使用情况、术中血流动力学、并发症以及结石清除率等围手术期指标。结果病人结石平均直径为2.2 cm,平均手术时间47.6分钟,平均激光碎石时间18.6分钟。术中建立碎石通道后、术后6小时和术后24小时VAS评分分别为2.7、3.5和2.2;术后6小时和术后24小时均无追加阿片类药物。术后2例病人出现发热,1例病人出现伤口渗血,1例病人出现轻微恶心,均通过保守治疗痊愈。平均住院时间6.4天。术后1个月评估结石清除率为95.6%,2例病人术后肾盏残留部分结石,行二期输尿管软镜碎石术后达到无石化。结论对于全身麻醉或硬膜外麻醉术后并发症风险增加的病人,超声引导下椎旁神经阻滞麻醉在PCNL术中应用的镇痛效果理想,安全性高,不良反应少,减少了病人对阿片类药物的需求,改善了疼痛。

Objective This study aims to assess the feasibility,safety and analgesic efficacy of paravertebral blockade(PVB)for percutaneous nephrolithotomy(PCNL).Methods The clinical data of 45 patients with upper urinary calculi treated by Shanghai Fourth People’s Hospital affiliated to Tongji University from March 2019 to December 2020 were retrospectively analyzed.Intraoperative hemodynamic changes were observed.Through visual analog pain scale(VAS)questionnaire survey were corded the degree of pain for establishing gravel channel,after 6 hours,and after 24 hours postoperatively,postoperative analgesic usage,hospitalization duration,postoperative complications and stone clearance rate,perioperative important parameters,adverse reactions during the operation.Results Of all the 45 patients,the mean diameter of the stones was 2.2 cm.The mean operative time was 47.6 min.The mean laser lithotripsy time was 18.6 min.The average VAS scores of intraoperatively and at 6 and 24 hours postoperatively were 2.7,3.5,and 2.2,respectively.No additional opioid drugs were needed 6 and 24 hours after the operation.The average hospital-in time was 6.4 d.Postoperative low fever occurred in 2 patients and amild bleeding wound appeared in 1 patient,and one had mild nausea.All of whom were cured by conservative treatment.One month after the operation,the stone clearing rate was 95.6%.Two patient had residual stone in the renal calyces after the operation,and the second stage flexible ureteroscope lithotripsy was performed to achieve stone-free.Conclusion For patients with increased risk of complications after general anesthesia or epidural anesthesia,ultrasound-guided paravertebral block anesthesia in PCNL has an ideal analgesic effect with high safety and few adverse reactions.This method reduces the need for opioids in patients undergoing PCNL,improves pain experience.