不同麻醉方法在输尿管中下段结石输尿管镜碎石术中麻醉效果的对照研究

Randomized and controlled trials on the effects of different anesthesia methods in the lower ureteral stones URL

目的比较三种不同的麻醉方法在输尿管中下段结石输尿管镜碎石术(URL)中的麻醉效果。方法将患者随机分为连续硬膜外麻醉(CEA)组、腰麻-硬膜外麻醉联合麻醉(CSEA)组以及腰麻组(CSA),每组各40例,比较三种麻醉方法的效果。结果麻醉起效时间和麻醉平面:CSA和CSEA组最短,CEA组最长,三种麻醉痛觉阻滞平面为T9平面都达到手术要求;单次推药麻醉持续时间:CSA组最长,CSEA组次之,CEA组最短;推入麻醉药物后血压下降患者三组比较,差异无统计学意义(P>0.05);术中麻醉优良患者:CSA组和CSEA组比较,差异无统计学意义(P>0.05),CSA组和CSEA组与CEA组比较,差异有统计学意义(P<0.05);腰背痛发生患者:CEA组和CSEA组两组比较,差异无统计学意义(P>0.05),CEA组和CSEA组与CSA组比较,差异有统计学意义(P<0.05)。结论 0.5%布比卡因2.5 mL CSA应用于输尿管中下段结石URL可作首选的麻醉方法。

Objective To compare the effects of three types of anesthesia in the lower ureteral stones URL.Methods The patients were divided into three groups（CEA,CSEA,CSA group）,each group had 40 cases.In CEA group,40 patients were narcotized by epidural anesthesia.In CSEA group,40 patients were narcotized by combined spinal epidural anesthesia and in CSA group,40 patients were narcotized by lumbar anesthesia.The effects of three types of anesthesia were evaluated.Results The onset times and reached maximum retardant times： CSEA group and CSA group were shorter than CEA group,the retardant surfaces of the three groups were all under T9 and reached the requirements.Single push drugs duration of anesthesia： CSA group was longer than CSEA group and CEA group（the shortest）（P 0.05）,the differences of blood pressure decreasing in three groups were not significant（P 0.05）.For the excellent anesthetic of the patients in surgery： there was no significant difference between the CSA group and CSEA group（P 0.05）,but there was a significant difference CSA group and CSEA group compared with CEA group（P 0.05）.The occurrence of back pain in the patients： there was no significant difference between the CEA group and CSEA group（P 0.05）,there was a significant difference CEA group and CSEA group compared with CSA group（P 0.05）.Conclusion The application of spinal anesthesia using 0.5% Bupivacaine 2.5 mL in TURP is safe and effective.It can be as preferred method of anesthesia in URL.