腰-硬联合麻醉在经皮肾镜取石术中的应用

Application of Combined Spinal-epidural Anesthesia in Percutaneous Nephrolithotomy

【目的】评估腰-硬联合麻醉应用于经皮肾镜取石术的安全性和效果。【方法】2006年3月至2009年8月采用腰硬联合麻醉行经皮肾镜取石术225例，对其临床资料进行回顾性分析。男153例，女72例。年龄20～73岁，平均45岁。硬膜外导管置于T10～11或T11～12，下点于L2～3或L3～4作蛛网膜下腔穿刺。【结果】麻醉时间90～240min，平均120min。灌洗液用量为18～63L，平均35L。无术后头痛、硬膜外穿刺穿破硬脊膜等麻醉相关并发症。患者均能耐受麻醉和手术操作，术后需镇痛者少。手术并发症包括因出血输血2例，胸膜损伤1例，单纯寒战8例，脓毒血症1例，经保守治疗或微创操作而得到控制。【结论】腰-硬联合麻醉可安全有效地应用于经皮肾镜取石术。

[Objective]To evaluate the efficacy and safety of combined spinal-epidural anesthesia in patients undergoing percutaneous nephrolithotomy （PCNL）. [Methods] The clinical data of 225 patients （153 males and 72 females） who underwent PCNL under combined spinal-epidural anesthesia at our center between March 2006 and August 2009 were analyzed retrospectively. Mean patient age was 45 years （ranged 20 to 73 years）. An epidural catheter was placed at the T10-11 or T11-12 interspace and spinal anesthesia was performed at either L2-3 or L3-4. [Results]Mean duration of the anesthesia was 120min （ranged 90 to 240min）. Mean volume of irrigation fluid was 35L （ranged 18 to 63L）. No major anesthesia-related complications occurred. All the procedures were well tolerated. The postoperative use of analgesics was minimal. The surgical complications included 2 bleeding, 1 pleural injury, 8 simple shivering and 1 sepsis. They were managed conservatively or minimally invasively （i. e. pleural drainage）. [Conclusion]The use of combined spinal-epidural anesthesia is safe and effective for patients undergoing PCNL.