氟芬合剂肾俞穴注射对体外冲击波碎石患者血液动力学的影响及镇痛效果

Impacts of the injection with flurphen mixture at Shenshu(BL 23)on hemodynamics and analgesia in patients with extracorporeal shock wave lithotripsy

目的:比较氟芬合剂(氟哌利多与枸橼酸芬太尼混合液)肾俞穴注射后行体外冲击波碎石术(ESWL)与单纯行常规ESWL患者的疼痛反应及血液动力学变化、临床疗效的差异。方法:将64例泌尿系结石拟行ESWL患者随机分为观察组和对照组,每组32例。观察组于碎石术前15~20min行氟芬合剂(氟哌利多注射液1.25mg、枸橼酸芬太尼注射液0.05mg,加0.9%NaCl溶液4.5mL稀释至6mL)双侧肾俞穴注射;对照组碎石术前不给予其他辅助治疗与药物治疗。观察两组患者手术中血压、心率的变化及疼痛视觉模拟评分(VAS)、结石完全排净所进行的碎石次数及首次碎石术后结石排净率。结果:对照组患者术中血压明显高于手术前,术中心率明显快于手术前(均P<0.05);观察组患者术中血压、心率与术前比较,差异无统计学意义(均P>0.05);观察组术中血压较对照组低、心率较对照组慢(均P<0.05)。观察组患者术中VAS评分明显低于对照组(均P<0.05)。观察组患者的碎石次数少于对照组,首次碎石术后1周内结石排净率高于对照组[75.0%(24/32)vs 50.0%(16/32),P<0.05]。结论:氟芬合剂肾俞穴注射能显著减轻体外冲击波碎石过程中患者的疼痛反应,避免了血液动力学的波动,提高了临床碎石效果。

Objective To compare the differences in pain reaction, hemodynamics and clinical efficacy between extracorporeal shock wave lithotripsy （ESWl.） after injection with flurphen mixture （mixture of droperidol and fentanyl citrate） at Shenshu （BL 23） and simple ESWL in the patients. Methods Sixty^four cases of urinary cal- culi with ESWL were randomized into an observation group and a control group, 32 cases in each one. In the ob- servation group, 15 to 20 min before ESWL, flurphen mixture （droperidol injection 1.25 mg and fentanyl citrate injection 0.05 mg were diluted to 6 mL with 0. 9% sodium chloride solution 4. 5 mL） was injected at bilateral Shenshu （BE 23）. In the eontrol group, no any adjuvant therapy and medication were used before ESWL. The changes in blood pressure and heart rate, visual analogue scale （VAS） score, lithotripsy frequency till calculi com- plete removal and the rate of calculi complete removal after the first lithotripsy were observed in the two groups. Results In the control group, blood pressure and heart rate were higher during lithotripsy than those before litho- tripsy （both P〈0.05）. In the observation group, the differences in blood pressure and heart rate were not signifi- cant statistically as compared with those before lithotripsy （both P〉0.05）. The blood pressure and heart rate during lithotripsy in the observation group were apparently lower than those in the control group （both P〈0.05）. VAS scores during lithotripsy in the observation group were lower apparently than those in the control group （both P〈（0.05）. The lithotripsy frequency in the observation group was less than that in the control group. The rate of calculi complete removal in 1 week after the first lithotripsy in the observation group was higher than that in the control group [75.0% （24/32） vs 50.0%（16/32）, P〈0.05]. Conclusion The flurphen mixture at Shenshu （BL 23） significantly alleViates pain reaction in patients undergoing ESWI., avoids the fluctuation of hemodyrlamics and improves the clinical effect of lithotripsy.