硬膜外与腰硬联合阻滞麻醉在输尿管结石弹道碎石术中的效果比较

Comparison of the effect of epidural anesthesia and combined spinal epidural anesthesia on trajectory lithotrity of air pressure

目的探讨连续硬膜外阻滞麻醉（CEA）和腰硬联合阻滞麻醉（CSEA）用于输尿管镜下气压弹道碎石术麻醉的临床效果。方法选择美国麻醉师协会（ASA）Ⅰ-Ⅱ级患有输尿管结石,需手术的患者100例,分为A、B两组,每组50例;A组行CEA,选择T11-12、L3-4两个穿刺点,硬膜外用药为0.5%罗哌卡因（赛乐品）12-18ml,B组行CSEA,选择L3-4穿刺点,用药为0.5%布比卡因轻比重溶液1.5-2.0ml,观察感觉起效时间,最大感觉阻滞平面,患者舒适度,术中及术后不良反应。结果两组患者手术期间麻醉效果无明显差异,均为优良。A组患者术中及术后恶心呕吐、头痛发生率明显低于B组,术后下肢活动功能恢复较B组快;B组麻醉起效时间明显低于A组（P〈0.05）。两组患者麻醉期间血压都有不同程度下降,B组下降幅度大于A组（P〈0.05）;麻醉期间心率A组无明显变化,B组较麻醉前有明显变化（P〈0.05）;两组患者麻醉前后氧饱和度无显著变化。结论两种麻醉方法均适用于输尿管镜下压弹道碎石手术,CEA较CSEA术中及术后并发症少,患者术后恢复较快,安全性较高,但麻醉起效时间相对较慢。

Objective To evaluate the anesthetic effect of epidural anesthesia and combined spinal epidural anesthesia on trajectory lithotrity of air pressure. Methods 100 patients with ASA Ⅰ - Ⅱ grade ureter concretion were divided into groups A and B randomly with 50 cases in each. Group A was given epidural anesthesia. The point of centesis was located at T11-12 and L3-4 and 12 - 18 ml of 0. 5% ropivaeaine was used. Group B was given combined spinal epidural anesthesia. The puncture point was at L3-4 and 1.5 -2.0 ml of 0. 5% bupivacaine was administrated. The effect-taking time, blocking plane, patients＇ cosiness degree and adverse effect were observed. Results There was no significant difference in anesthetic effect between the two groups. The incidences of nausea and vomiting, and headache during and after operation were lower in group A than B. The functional recovery of lower limbs was quicker in group A than B（ P 〈 0. 05 ）. The effect-taking time of anesthesia was shorter in group B than A. Blood pressure in both groups was descended during anesthetic period, but it was more obvious in group B （P 〈 0. 05 ）. There was no significant change in heart rate in group A, but there was in group B （ P 〈 0. 05 ）. There was no evident change in O2 saturation before and after anesthesia in both groups Conclusion Both anesthetic methods are applicable to trajectory lithotrity of air pressure, in which epidural anesthesia is preferred because it has the advantages of less complications, quicker postoperative recovery, and more safety, but the effect-taking time is relatively slower.