腰麻联合硬膜外麻醉与气管插管全身麻醉在输尿管软镜肾结石钬激光碎石术中的应用效果

Application effect of spinal anesthesia combined with epidural anesthesia and tracheal intubation for general anesthesia in holmium laser lithotripsy of ureter soft endoscopic renal calculi

目的探讨腰麻联合硬膜外麻醉与气管插管全身麻醉在输尿管软镜肾结石钬激光碎石术中的应用效果。方法选取2017年1月~2018年12月我院收治的60例输尿管软镜肾结石钬激光碎石术患者作为研究对象,按照随机数字表法将其分为对照组(30例)与研究组(30例)。对照组实施腰麻联合腰麻硬膜外麻醉(CSEA),研究组实施气管插管全身麻醉(GA)。比较两组的术后血流动力学,包括心率(HR)、收缩压(SBP)、舒张压(DBP),不同时间段视觉模拟评分量表(VAS)评分;比较两组的体动、进镜困难及术中不适发生情况。结果研究组的体动、进镜困难、术中不适发生率均低于对照组,差异有统计学意义(P<0.05)。研究组的HR、DBP均高于对照组,差异有统计学意义(P<0.05)。研究组的SBP低于对照组,差异有统计学意义(P<0.05);两组的术前评分、术中1 h、术毕VAS评分比较,差异无统计学意义(P>0.05)。结论GA用于输尿管软镜肾结石钬激光碎石术的安全性和有效性更优于CSEA,值得临床推广应用。

Objective To investigate the application effect of spinal anesthesia combined with epidural anesthesia and tracheal intubation for general anesthesia in holmium laser lithotripsy of ureter soft mirror renal calculi.Methods Sixty patients with renal calculus undergone holmium laser lithotripsy under ureteroscope were enrolled in our hospital from January 2017 to December 2018 as subjects.They were divided into the control group(n=30)and the study group(n=30)according to the random number table method.In the control group,combined spinalepidural anesthesia(CSEA)was used,while in the study group,tracheal intubation for general anesthesia(GA)was performed.The hemodynamics of the two groups were compared,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),visual analogue scale(VAS)score in different time periods,the occurrence of body movement,difficulty in endoscopy and intraoperative discomfort.Results The incidence of motor movement,difficult endoscopic access and intraoperative discomfort in the study group were lower than those in the control group,with statistically significant differences(P<0.05).The HR and DBP of the study group were higher than those of the control group,and the differences were statistically significant(P<0.05).The SBP of the study group was lower than that of the control group,the difference was statistically significant(P<0.05).There were no statistically significant differences in preoperative VAS score,intraoperative 1 h VAS score and postoperative VAS score between the two groups(P>0.05).Conclusion GA is better than CSEA in safety and efficacy of holmium laser lithotripsy for ureteral calculi under soft ureteroscope,and is worthy of clinical application.