针药复合麻醉在近端输尿管结石钬激光碎石术中的应用研究

Application of acupuncture medicine anesthesia in holmium laser lithotripsy for proximal ureter stone

目的观察近端输尿管结石钬激光碎石术中针药复合麻醉的效果。方法将63例近端输尿管结石患者随机分为治疗组(34例)和对照组(29例),治疗组采用针药复合麻醉,行输尿管镜钬激光碎石术;对照组采用腰麻,行输尿管镜钬激光碎石术;分别于麻醉前、术中、术后观察患者的各项生命体征、相关临床生化指标,术后评价临床镇痛疗效。结果治疗组麻醉前、术中、术后收缩压、心率和血氧饱和度比较,差异无统计学意义(P>0.05);对照组术中、术后心率与麻醉前比较,差异有统计学意义(P<0.05);组间术中、术后同期比较,心率差异有统计学意义(P<0.05)。治疗组术中与麻醉前比较,胰岛素、皮质醇差异有统计学意义(P<0.05);术后与麻醉前比较,血糖、胰岛素差异有统计学意义(P<0.05);术后与术中比较,胰岛素、皮质醇差异有统计学意义(P<0.05)。对照组术中与麻醉前比较,胰岛素、皮质醇差异有统计学意义(P<0.05);术后与麻醉前比较,血糖、胰岛素差异有统计学意义(P<0.05);术后与术中比较,血糖、胰岛素、皮质醇差异有统计学意义(P<0.05)。组间术中比较,胰岛素、皮质醇差异有统计学意义(P<0.05);术后比较,血糖差异有统计学意义(P<0.05)。治疗组、对照组镇痛总有效率分别为91.2%、89.7%;组间镇痛效果比较,差异无统计学意义(P>0.05)。治疗组术中、术后一般情况良好,对照组术后有8例患者出现穿刺点疼痛、腰酸、恶心、呕吐、头痛等。结论针药复合麻醉用于钬激光碎石术治疗近端输尿管结石的麻醉效果良好,对生理活动干扰少,无明显的临床不良反应。

Objective To observe the effect of acupuncture medicine anesthesia in holmium laser lithotripsy.Methods Sixty-three cases of proximal ureter stone were randomized into treatment group and control group.Thirty-four cases in treatment group were treated by acupuncture medicine anesthesia,and 29 cases in control group were treated by lumbar anesthesia.The vital sign and biochemistry index were observed before anesthesia,during operation and after operation.The clinical analgesia was evaluated after operation.Results There was no statistical significant difference in systolic pressure,heart rate and oxyhemoglobin saturation between pre-operation,intra-operation and post-operation in treatment group（P0.05）,while with statisticall significant differences in control group（P0.05）.The difference of heart rate during operation and after operation was significant between the groups（P0.05）.In treatment group,the differences of insulin and cortisol between intra-operation and pre-operation were significant（P0.05）;the differences of blood sugar and insulin between pre-operation and post-operation were significant（P0.05）,and the differences between post-operation and intra-operation were significant（P0.05）.In control group,the differences of insulin and cortisol between intra-operation and pre-operation were significant（P0.05）;there were significant differences in blood sugar and insulin between post-operation and pre-operation（P0.05）;there were significant differences in blood sugar,insulin and cortisol between post-operation and intra-operation（P0.05）.During operation,there were significant differences in insulin and cortisol between the groups（P0.05）;after operation,there was a significant difference in blood sugar（P0.05）.The total effective rates were 91.2% and 89.7% in treatment group and control group respectively;the analgesic effect between the groups was in significant（P0.05）.The patients in treatment group were under good condition during and after operation,and 8 cases in control group had pain in puncturing points,soreness of waist,nausea,vomit and headache.Conclusion Acupuncture medicine anesthesia has good effect on holmium laser lithotripsy for proximal ureter stone,without obvious side effects.