腰硬联合阻滞和全身麻醉用于经皮肾镜取石术的比较

Comparision study of combined spinal-epidural anesthesia versus general anesthesia in percutaneous nephrolithotomy procedures

目的观察腰硬联合麻醉(CSEA)和全身麻醉(GA)下经皮肾镜碎石术(PCNL)的有效性和安全性。方法 90例患者随机分为CSEA组(n=45)和GA组(n=45)。术中监测血压、心率、呼吸、血氧饱和度变化及不良反应。结果两组患者在年龄、体重、性别、ASA分级和手术时间方面无差异。两组均无大的手术或麻醉并发症。全麻组发生低血压17例,腰硬联合组发生低血压5例(P<0.05)。腰硬联合组在手术开始60min后,有15例患者需要丙泊酚镇静。术后2h腰硬联合组有1例患者需要静脉给予止痛药,全麻组有34例患者需要静脉给予止痛药止痛(在PACU中)(P<0.01)。术后24h全麻组有42例患者满意,腰硬联合组有41例患者满意(P>.05)。结论腰硬联合麻醉复合镇静用于PCNL手术具有患者满意度高,麻醉并发症低,术后镇痛效果好的优点,是PCNL手术麻醉方法的一种选择。

Objective To compare the safety and efficacy of percutaneous nephrolithotomy performed under combined spinal-epidural anesthesia （CSEA） and general anesthesia （GA）. Methods Ninety patients who underwent percutaneous nephrolithotomy were randomly enrolled into group CSEA an group GA. Conditions such as the blood pressure, heart rate, respiration, oxyhemoglobin saturation, untoward effects and comfort score in these two groups were evaluated. Results The clinical characteristics of the patients in each group, such as age, weight, gender, ASA sataus and operative time, had no significant differences. Major intraoperative or postoperative complications such as visceral, vascular, and neurologic injury or unusual bleeding did not occur in all of the patients. Hypotension was observed in 5 and 17 patients of group CSEA and group GA, respectively （P〈0.05）. The analgesic requirement was significantly higher in group GA than thai： in group CSEA. Conclusions Combined spinal-epidural anesthesia is a feasible and safe technique in PCNL operations, for the higher comfort feeling, lower complication rate and better antalgie effects.