微创经皮肾穿刺气压弹道碎石术的麻醉观察

Anesthesia management of minimally invasive percutaneous nephrolithotomy.

目的:观察硬膜外麻醉下行微创经皮肾穿刺气压弹道碎石术(PCNL)不同时点静注辅助用药的麻醉效果及安全性。方法:60例行PCNL病人,ASAⅠ～Ⅱ级,随机分成3组,每组2 0例。均行硬膜外T1 2 ～L1 麻醉。Ⅰ组(对照组)不用辅助药;Ⅱ组术前静注曲马多50～1 0 0mg,咪唑安定2～3mg ;Ⅲ组俯卧位后静注辅助药同Ⅱ组。监测血压(SBP、DBP)、心率(HR)、病人的反应及感受;记录麻醉2 0min、截石位后、俯卧位后、术中1h和2h及术毕血压和心率变化并与基础值比较。结果:3组病人麻醉镇痛均满意;体位变动前生命体征稳定,截石位后心率无显著变化,但血压均有显著下降(P <0 .0 1 ) ;出现低血压需用升压药或加用阿托品例数组间无显著性差异(P >0 . 0 5) ;术中出现肌颤或躁动者Ⅰ组与Ⅲ组比较有显著性差异(P <0 . 0 5) ,Ⅰ组与Ⅱ组比较有极显著性差异(P <0 . 0 1 ) ,Ⅱ组与Ⅲ组无显著性差异。结论:PCNL中两次体位变动可致循环波动,硬膜外麻醉加静脉辅助用药效果满意。

Objective:To observed the effect and safety of intravenous assistant in minimally invasive percutaneous nephrolithotomy (PCNL).Methods:sixty ASA Ⅰ～Ⅱ patients undergoing PCNL were divided randomly into three groups with 20 cases each.All patients were accepted with epidural anesthesia.The patients in group I(control group)were injected nothing intravenously and group Ⅱ were injected tramadol 50～(100 mg) and midazolam 2～(3 mg) before operation;group Ⅲ were the same medicine after prostrate position.ECG,BP,HR,SPO\-2,and the patients'response are monitored and recorded during the procedure.Results:The effect of anesthesia were satisfactory in all patients.The vital signs were steady before the position changed.The blood pressure in three groups was decreased significantly after lithotomy position as compared with the baseline(P<0.05),but this change was not significantly different in each groups,the number of patients who must be given pressor drug or atropine being hypotension was not significantly different in each groups(P<0.05).The frequency of myopalmus and dysphoria was significantly different between group I and Ⅲ(P<0.05),and profound significantly different between group I and Ⅱ(P<0.01),and was not significantly different between group Ⅱ and Ⅲ.Conclusions:The shift of surgical,position can resulted to circulatory fluctuate.The epidural anesthesia combined intravenous assistant can be used effectively and safely for PCNL.