麻醉监测管理技术在微创经皮肾镜取石术中的应用

The Application of Anesthetic Monitoring and Management Technology in Minimally Invasive Percutaneous Nephrolithotomy of Lithotomy

目的观察麻醉监测管理技术（MAC）加局部浸润麻醉在微创经皮肾镜取石术（MPCNL）中的应用,探讨其效果及安全性。方法 2009年5月至2010年4月行MPCNL手术34例,由患者自行选择麻醉方式,分为TIVA组、CSEA组和MAC组,监测患者的HR、MAP、SpO2,观察各组的麻醉效果和住院费用,进行统计学分析。结果 3组患者均镇痛满意,手术时间及住院日比较无统计学意义（P〉0.05）,CSEA组和MAC组的住院费用均少于TIVA组（P〈0.01）;CSEA组有2例患者术中出现躁动。CSEA组和MAC组患者术中呼吸平稳,SpO2均能保持在96%以上。俯卧位后2~5min,CSEA组患者的MAP有明显下降,与麻醉前相比P〈0.01,其中有6例（75%）患者需要使用缩血管药物;而TIVA组、MAC组患者的HR、MAP与俯卧位前无明显变化。MAC组患者的丙泊酚平均输注速率为（2.05±0.72）mg/（kg？h）,术中OAA/S评分全部为3~4分,镇静、镇痛满意。结论 MAC加局部浸润麻醉用于MPCNL创伤小、效果切实安全、费用低,值得临床推广应用。

Objective To investigate the management of anesthesia monitoring （MAC） plus local anesthesia in the minimally invasive percutaneous nephrolithotomy lithotomy （MPCNL） application, to explore its effect and safety. Methods May 2009 ~ April 2010 MPCNL operation line 34, by the patient to choose anesthesia, were divided into TIVA group, CSEA group and the MAC Group, monitoring of patients with HR, MAP, SpO2, the anesthetic effects were observed and hospitalization costs were statistically analyzed. Results Three groups of patients were satisfied with analgesia, surgical time and hospital stay was not statistically significant （P0.05）, CSEA group and the MAC group, hospital costs were less than TIVA group （P0.01）; CSEA group 2 patients intraoperative restlessness. CSEA group and the MAC smooth breathing surgery patients, SpO2 above 96% is maintained. Prone position after the 2 ~ 5min, CSEA group were significantly decreased MAP, compared with those before anesthesia P0.01, of which 6 cases （75%） patients need to vasoconstrictor drugs; the TIVA group, MAC group were HR, MAP with no significant changes before the prone position. MAC group were the average propofol infusion rate （2.05 ± 0.72） mg/（kg · h）, patients in the OAA/S score of 3 to 4 minutes total, sedation, analgesia satisfaction. Conclusion MAC MPCNL plus local anesthesia for trauma, the effect is truly safe, low cost, is worthy of clinical application.