两点法腰硬联合麻醉用于经皮肾镜钬激光碎石术的临床研究

Clinical Study on Two-Point Combined Spinal Epidural Anesthesia in Percutaneous Holmium Laser Nephrolithotomy

目的探讨两点法腰硬联合麻醉用于经皮肾镜钬激光碎石术的临床效果。方法选取2016年1月至2018年1月于我院行经皮肾镜钬激光碎石术治疗的400例患者,随机分为对照组与观察组各200例。对照组应用连续硬膜外麻醉,观察组采用两点法腰硬联合麻醉,对比两组的麻醉效果、术中血流动力学及不良反应情况。结果观察组的麻醉起效时间、阻滞完善时间明显短于对照组,麻醉用药总量少于对照组(P均<0.05)。T1时刻,两组的MAP、 SpO2、 HR水平及VAS评分比较均无统计学差异(P>0.05); T2时刻,对照组的MAP、 SpO2、 HR水平及VAS评分均明显高于观察组,且两组的VAS评分低于T1时刻(P均<0.05)。观察组的术中不良反应发生率明显低于对照组(P <0.05)。结论两点法腰硬联合麻醉用于经皮肾镜钬激光碎石术的效果显著,既能达到良好的镇痛效果,也不会对血流动力学造成影响,具有较高的用药安全性,值得临床推广。

Objective To study the clinical effect of two-point combined spinal epidural anesthesia in percutaneous holmium laser nephrolithotomy.Methods 400 cases of patients undergoing percutaneous holmium laser nephrolithotomy in our hospital from January 2016 to January 2018 were selected and randomly divided into control group and observation group,with 200 cases in each group.The control group received continuous epidural anesthesia,while the observation group received two-point combined spinal epidural anesthesia.The anesthesia effect,intraoperative hemodynamics and adverse reactions were compared between the two groups.Results The anesthesia onset time and block improvement time were significantly shorter than those of the control group,and the total anesthesia dosage was less than that of the control group(all P<0.05).No statistical difference was found in the MAP,SpO2 and HR levels,and VAS score at T1 between the two groups(P>0.05).At T2,the MAP,SpO2 and HR levels and VAS score of the control group were significantly higher than those of the observation group,and the VAS scores of both groups were significantly lower than those at T1(P<0.05).The incidence of intraoperative adverse reactions of the observation group was significantly lower than that of the control group(P<0.05).Conclusions Two-point combined spinal epidural anesthesia in percutaneous holmium laser nephrolithotomy has significant effect,can achieve the good analgesic effect without affecting emodynamics,and has higher medication safety,which is worthy of clinical promotion.