硬膜外阻滞治疗输尿管结石及疼痛16例体会

Epidural block in the treatment of ureteric stones and pain:A report of 16 cases

目的观察硬膜外阻滞对经过筛选的输尿管结石及疼痛病例的治疗效果。方法急性输尿管结石患者16例,结石直径在0．4 cm～1．2 cm,经B型超声波检查或X线平片确诊后立即行硬膜外阻滞,取L1～2间隙置管并注入1．5％利多卡因15 ml～20 ml,之后并用扩容、利尿及头高斜坡健侧卧位下的物理捶打等治疗措施,治疗后观察结石排出,否则接镇痛泵,并进行第2次治疗。结果16例患者治疗后疼痛等症状迅速消失,有13例输尿管结石排出体外,1例注入膀胱,2例无效。治愈率为81．3％(13例),总有效率87．5％(14例)。结论直径<1．0 cm,发病时间<30 h的输尿管结石采取硬膜外阻滞治疗是有效的排石方法,且止痛理想,无创伤和并发症。

Objective To investigate the effects of epidural block on the treatment of ureteric stones and evaluate the analgesic effects in selected cases. Methods Sixteen hospitalized patients suffering from acute ureteric stones, diagnosed by ultrasound and X-ray were selected. The diameter of stones was 4-12 ram. The patients were placed a catheter in the epidural space at the level of L1-2, 1.5% lidocaine 15-20 ml was administered to achieve segmental blockade. High volume fluids were infused and rapidly acting diuretics were given. At the same time, let the patients keep the posture of ipsilateral head-high slope and give them physical knocking to help expelling stones. After checking if the stones entered the bladder, or expelled out of the body ,otherwise ,linked the catheter with analgesic pump and began the second therapy. Results All the patients＇ pain were relieved immediately. In 13 patients,the stones expelled out; in 1 patient the stones entered into the bladder,and the remaining 2 patients had no effects. The cure rate was 81. 3% （ 13 cases） and the total effect rate was 87.5% （ 14 cases）. Conclusion For the patients with ureteric stones which diameters are smaller than lOmm and the history of disease is shorter than 30 h ,epidural block is an effective,in addition to providing pain relief,mad noninvasive method to expel stone and without complications.