腰硬联合麻醉在经尿道输尿管镜弹道碎石手术中的应用

Application of epidural anesthesia on pneumatic lithotripsy under ureteroscope

目的研究分析腰硬联合麻醉在经尿道输尿管镜弹道碎石的临床麻醉特点。方法采用回顾性研究的方法对我院在2011年11月至2013年11月期间收治的60例泌尿结石患者临床资料进行分析,将所有患者随机分为研究组和对照子,研究组采用腰硬联合麻醉(CSEA)方法,对照组采用硬膜外麻醉(CEA)方法,采用基本情况(手术时间、病情等)、麻醉效果、肌松满意率和不良反应发生率(头痛、麻醉纠正等)评价各麻醉方式的麻醉效果。结果两种麻醉方法在不良反应发生率和基本情况之间无显著性差异(P>0.05),但研究组肌松满意率更高,为100%,两组差异具有统计学意义(P<0.05);就麻醉效果而言,研究组麻醉时间更长(麻醉维持时间116±24 min),起效快(麻醉平面固定时间9.2±1.3 min),对照组麻醉时间短(麻醉维持时间38±23 min),起效慢(麻醉平面固定时间11.8±5.7 min),两组之间存在显著性统计学差异(P<0.01)。结论两种麻醉方法各有优缺,CEA麻醉起效时间长,具有较高的可控性,且呼吸系统的副反应较少,但CSEA起效时间短,阻滞完善,同时具有硬膜外麻醉和腰麻的优势,且具有较高的肌松满意率和较广的麻醉平面,麻醉时间长,副作用小,值得临床推广使用。

Objective To analyze the clinical anesthesia characteristics of epidural anesthesia on pneumatic lithotripsy under ureteroscope. Methods To study the clinical information of 60 cases treated in our hospital from November 2011 to November 2013 with a retrospective study, and divide them into two groups randomly： the research group with combined spinal epidural anesthesia （CSEA） and the control group with continuous epidural anesthesia（ CEA）, and evaluate effect with the basic situation （ operation time , illness , etc. ） , anesthesia, muscle relaxants satisfaction rate and incidence of adverse reactions （headache, anesthesia corrected , etc. ）. Results The adverse reaction rate and the basic situation between two group had no significant difference （P 〉 0. 05） ,but the muscle relaxants satisfaction rate in research group（ 100% ） was higher than control group with a statistically significant difference （ P 〈 0. 05 ）. Compared the anesthesia effect, the research group with longer effect （ anesthesia duration 116 ± 24min）, longer onset time （ anesthesia fixed time 9. 2 ± 1.3min）, and in control group with shorter effect（38 ± 23min）, lower onset time（ 11.8 ± 5.7min）, there was a significant statistical difference （P 〈 0. 01 ） between the two groups. Conclusions Both methods have advantages and disadvantages： CEA with longer narcotic effect, higher controllability, fewer side effects, but CSEA onset time is short, block sound , but CSEA has merits of fast and precise effect, little side effect, a much higher satisfaction rate, and advantages of both epidural anesthesia and spinal anesthesia, which is worthy of clinical use widely.