经尿道输尿管镜下弹道碎石术的麻醉

Anesthesia for Trans-urethral Ureteroscope Pneumatic Lithotripsy

目的:观察比较硬膜外麻醉(EA)和腰麻-硬膜外联合麻醉(CSEA)两种麻醉方法,用于输尿管镜及气压弹道碎石器行经尿道输尿管镜下碎石术(URL)的麻醉效果及并发症,探讨尿道输尿管镜下碎石手术的麻醉方法。方法:选择ASAⅠ-Ⅱ级、年龄18岁～65岁拟行尿道输尿管镜下碎石术的患者80例,随机分为腰麻—硬膜外联合麻醉和硬膜外麻醉两组;每组40例,采用针刺法测定麻醉平面,观察两组病例用药量、起效时间,上升到各个麻醉平面上界的时间及麻醉效果;术中患者出现低血压、寒战、术后头痛、腰背痛发生率。结果:腰麻硬膜外联合麻醉组的起效时间、麻醉平面上升时间均比硬膜外麻醉组快,且用药量少(P<0.01),两组低血压、术后头痛、腰背痛发生率差异无显著性(P>0.05),寒战发生率腰麻硬膜外联合麻醉组小于硬膜外麻醉组(P<0.01)。结论:腰麻硬膜外联合麻醉麻醉方式有起效快、效果确切、副作用小的优点,是尿道输尿管镜下碎石手术较好的麻醉方法之一。

Objective To compare the effects and complications of epidurai anesthesia（EA） and combined sinai and epidural anesthesia（CSEA） for trans-urethrai ureteroscope lithotripsy（ URL）, and to discuss anesthesia methods for URL. Methods Eighty ASA physical status Ⅰ and Ⅱ patients 18～65 years of age, scheduled for URL, were randomized into group CSEA （n = 40） and group EA （n = 40）. Pin-prick method was employed to determine anesthesia level, and local anesthetic dosage, onset time, time to attain optimal anesthesia level and anesthesia effect were recorded. Hypotension, shiver, post-operative headache and lumbodorsai pain were observed. Results Compared to group EA, group CSEA showed more rapid onset and shorter time to attain optimal anesthesia level with more little local anesthetic（P 〈0.01 ）. There is not any significant difference in hypotension, post-operative headache and lumbodorsai pain between the two groups （P 〉 0. 05 ）, incidence of shiver was lower in group CSEA than in group EA （P 〈0.01 ）. Conclusions CSEA is an optimal method for URL for its rapid onset, securely effect and little complication.