不同麻醉方式输尿管镜钬激光碎石术的疗效比较

Comparison of the effects of ureteroscopic holmium laser lithotripsy with different anesthesia methods

目的比较局麻和全身麻醉、持续硬膜外麻醉下输尿管镜钬激光碎石术(URL)的疗效。方法选取2017年2月~2019年2月收治的90例输尿管结石患者为研究对象,均择期行URL手术治疗,按照麻醉方法不同分为局麻组、全麻组、持硬麻醉组,每组各30例。记录并比较3组围手术期生命体征变化[平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)]、手术时间、住院时间、术后胃功能恢复情况及结石清除率、结石返回肾脏情况、并发症发生率。结果术中3组患者HR均增加,MAP下降,且局麻组HR显著低于全麻组和持硬麻醉组,MAP显著高于全麻组和持硬麻醉组(P<0.05);术后,局麻组HR、MAP恢复正常,但全麻组和持硬麻醉组HR仍高于术前,MAP仍低于术前(P<0.05);围术期3组患者SpO2比较,差异无统计学意义(P>0.05);局麻组手术时间、住院时间及术后胃功能恢复时间均显著短于全麻组和持硬麻醉组,结石返回肾脏的比例及并发症发生率均显著低于全麻组和持硬麻醉组(P<0.05)。结论局麻下行URL治疗输尿管结石可维持患者围术期生命体征稳定,手术耐受性较好,术后胃肠道功能恢复快,结石排净率高,并发症少。

Objective To observe and compare the efficacy of ureteroscopic holmium laser lithotripsy(URL)under local anesthesia and general anesthesia and continuous epidural anesthesia.Methods 90 patients with ureteral calculi admitted to department of urinary surgery of our hospital from February 2017 to February 2019 were selected for the study,and given selective URL surgery.According to different anesthesia methods,they were divided into local anesthesia group,general anesthesia group and continuous epidural anesthesia group,with 30 cases in each group.The perioperative vital signs[mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO2)],operative time,hospital stay,postoperative recovery of gastric function,stone clearance rate,stones returning to kidney and incidence rate of complications were recorded and compared among the three groups.Results The HR during operation in the three groups was increased while the MAP was decreased,and the HR in local anesthesia group was significantly lower than that in general anesthesia group and continuous epidural anesthesia group,while the MAP was significantly higher than that in general anesthesia group and continuous epidural anesthesia group(P<0.05).After operation,the HR and MAP in local anesthesia group returned to normal,but the HR in general anesthesia group and continuous epidural anesthesia group was still higher than that before operation while the MAP was still lower than that before operation(P<0.05).There was no statistically significant difference in the SpO2during perioperative period among the three groups(P>0.05).The operative time,hospital stay and postoperative recovery of gastric function in local anesthesia group were significantly shorter than those in general anesthesia group and continuous epidural anesthesia group,and the proportion of stones returning to kidney and the incidence rate of complications were significantly lower than those in general anesthesia group and continuous epidural anesthesia group(P<0.05).Conclusion URL under local anesthesia for ureteral calculi can maintain stable perioperative vital signs,and it has low requirements for cardiopulmonary function,good surgical tolerance,the gastrointestinal function recovered quickly after operation,high stone removal rate and few complications.