基于ERAS理念下经皮肾镜碎石术患者的麻醉管理

The Anesthetic Management of Patients with Percutaneous Nephrolithotripsy Based on the Concept of ERAS

目的:探讨在快速康复外科理念的指导下,将与此相适应的快通道麻醉应用于经皮肾镜钬激光碎石术中的安全性及可行性。方法:选取2017年2-8月择期行经皮肾镜钬激光碎石术患者140例,将2017年6-8月在多学科合作快速康复外科模式下行经皮肾镜钬激光碎石术患者70例设为观察组,术前禁饮2h,禁食6h,术前2h饮用含碳水化合物液体,术前不做肠道准备,围术期全程注意保温,所使用液体和冲洗液均加温至37℃左右,术中采用限制性补液策略,术后采用多模式镇痛等处理;将2017年2-5月传统常规模式下行经皮肾镜钬激光碎石术患者70例设为对照组,即术前禁食12h,禁饮8h,术前肠道准备,术中常规补液等传统模式处理。两组患者均采用气管插管全身麻醉施行手术。结果:观察组患者术后苏醒时间、拔除气管导管时间、转出PACU时间均短于对照组,术后发生恶心呕吐、低体温、寒战等并发症例数均低于对照组,差异有统计学意义(P<0.05)。结论:快速康复外科理念在经皮肾镜钬激光碎石手术麻醉管理中的应用,可以减轻手术患者的应激反应,加速快速康复。

Objective：To explore the safety and feasibility of the fast-channel anesthesia in percutaneous nephroholmium laser lithotripsy under the guidance of the rapid rehabilitation surgery concept.Methods：Selection in February 2017 to August elective suffer nephroscope holmium laser lithotripsy patient 140 examples,will be on June 2017 to August in multidisciplinary cooperation fast rehabilitation surgical mode suffer nephroscope holmium laser lithotripsy in patients with 70 cases as observation group,preoperative the drink 2 h,fasting,6 h,2 hpreoperative drinking liquid containing carbohydrates,don＇t do the intestinal preoperative preparation,perioperative full notice heat preservation,all liquid and washing fluid used heating to 37℃ or so,intraoperative restrictive rehydration strategy,by adopting the process of multimodal analgesia after;from February 2017 to May suffer nephroscope traditional regular mode of holmium laser lithotripsy in patients with 70 cases as control group,the preoperative fasting 12 h,the drink 8 h,preoperative bowel preparation,intraoperative conventional rehydration and dealing with the traditional model.Both groups were operated by endotracheal intubation general anesthesia.Results：Observation group of patients in the postoperative waking time,pulling the endotracheal tube time,turn the PACU time is shorter than the control group,the difference was statistically significant（P〈0.05）,postoperative nausea and vomiting,low temperature,chills and other complications were observed group were lower than the control group,the difference was statistically significant（P〈0.05）.Conclusion：The application of rapid rehabilitation surgery in the anesthesia management of holmium laser lithotripsy can alleviate the stress response of patients and accelerate the rapid recovery.