芬太尼联合丁卡因胶浆小剂量硬膜外麻醉在经皮肾镜碎石术中的应用价值

Application value of low-dose epidural anesthesia with Fentanyl and Tetracaine Jelly in percutaneous nephrolithotripsy

目的探讨芬太尼联合丁卡因胶浆小剂量硬膜外麻醉在经皮肾镜碎石术中的应用价值。方法选取我院2016年10月～2017年10月收治的152例需经皮肾镜碎石术治疗患者作为研究对象,按照双盲数字表方法分为单纯组(76例)与联合组(76例)。单纯组采用单纯硬膜外麻醉方法,联合组采用芬太尼联合丁卡因胶浆小剂量硬膜外麻醉方法。比较两组的心动过缓发生情况、低血压发生情况、不同时间点(麻醉前、安置输尿管导管时、碎石5 min、碎石20 min)血流动力学各指标[平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及心率(HR)]的变化情况。结果两组的心动过缓发生率、低血压发生率比较,差异无统计学意义(P>0.05)。两组麻醉前、安置输尿管导管时、碎石5 min及碎石20 min时的SpO2比较,差异无统计学意义(P>0.05)。两组麻醉前的MAP、HR比较,差异无统计学意义(P>0.05)。联合组安置输尿管导管时、碎石5 min及碎石20 min时的MAP、HR均低于单纯组,差异有统计学意义(P<0.05)。结论在经皮肾镜碎石术中,采用芬太尼+丁卡因胶浆联合小剂量硬膜外进行麻醉,可减少对患者血流动力学稳定性的影响,安全性高,值得临床推广应用。

Objective To investigate the application value of low-dose epidural anesthesia with Fentanyl and Tetracaine Jelly in the percutaneous nephrolithotripsy.Methods A total of 152 patients who underwent percutaneous nephrolithotripsy in our hospital from October 2016 to October 2017 were enrolled.The patients were divided into the single group(n=76)and tha combined group(n=76)according to a double-blind digital table method.In the single group,epidural anesthesia alone was used,and in the combined group,a small dose of epidural anesthesia with Fentanyl and Tetracaine Jelly was adopted.The occurrence of bradycardia and hypotension,and haemodynamics indexes including mean arterial pressure(MAP),saturation of pulse oximetry(SpO2),and heart rate(HR)at different time points including before anesthesia,placement of ureteral catheter,5-min lithotripsy,and 20-min lithotripsy were compared in the two groups.Results There was no significant difference in the incidence of bradycardia and hypotension between the two groups(P >0.05).There was no significant in SpO2 before anesthesia,at placement of ureteral catheter,5-min lithotripsy,and 20-min lithotripsy in the two groups(P >0.05).There was no significant difference in MAP and HR between the two groups before anesthesia(P >0.05).While during the ureteral catheter placement,at 5-min lithotripsy,and 20-min lithotripsy in the combined group,both MAP and HR were lower than those in the single group,with statistical significance(P<0.05).Conclusion In percutaneous nephrolithotripsy,Fentanyl combined with Tetracaine Jelly at a low-dose epidural anesthesia can reduce the impact on hemodynamic stability of patients.It is safe and worthy of promotion and application in clinic.