喉罩通气全身麻醉与腰硬联合麻醉对输尿管镜钬激光碎石术患者麻醉效果、血流动力学和应激反应的影响

Effects of General Anesthesia with Laryngeal Mask Ventilation and Combined Lumbar and Epidural Anesthesia on Anesthesia Effect,Hemodynamics and Stress Response in Patients Undergoing Ureteroscopic Holmium Laser Lithotripsy

目的:探讨喉罩通气全身麻醉与腰硬联合麻醉对输尿管镜钬激光碎石术患者麻醉效果、血流动力学以及应激反应的影响。方法:回顾性分析2018年2月至2021年2月在我院行输尿管镜钬激光碎石术治疗的输尿管结石患者114例的资料,根据麻醉方法分组:观察组(58例),采用喉罩通气全身麻醉;对照组(56例),采用腰麻-硬膜外联合麻醉。比较两组麻醉效果,监测各时段患者血流动力学变化、应激反应及躁动率。结果:两组自主呼吸恢复时间、拔管时间、言语应答时间、睁眼时间、定向力恢复时间比较均无统计学差异(P>0.05)。两组麻醉后气管导管插入即刻(T1)、手术开始10 min(T2)、拔管后10 min(T3)时的血氧饱和度(Sp O_(2))、平均动脉压(MAP)、心率较T0均有所降低(P<0.05),而观察组T1、T2、T3时的SpO_(2)、MAP、心率均低于对照组(P<0.05)。两组手术开始10 min、术后30 min、术后24 h后的去甲肾上腺素(NE)、皮质醇(COR)含量较术前均有所升高(P<0.05),而观察组手术开始10 min、术后30 min、术后24 h后的NE、COR含量均低于对照组(P<0.05)。观察组术后6 h、术后24 h、术后48 h的躁动率均低于对照组,差异有统计学意义(P<0.05)。结论:喉罩通气全身麻醉、腰硬联合麻醉在输尿管镜钬激光碎石术中的麻醉效果相当,但喉罩通气全身麻醉更有助于稳定血流动力学,减轻机体应激反应,镇静效果更好。

Objective:To explore the effects of general anesthesia with laryngeal mask ventilation and combined lumbar and epidural anesthesia on anesthesia effect,hemodynamics and stress response in patients undergoing ureteroscopic holmium laser lithotripsy.Methods:Data of 114 patients with ureteral calculi who were treated by ureteroscopic holmium laser lithotripsy in our hospital from February 2018 to February 2021 were retrospectively analyzed.According to the anesthesia methods,the observation group(58 cases)was treated with laryngeal mask ventilation and general anesthesia.The control group(56 cases)was treated with combined lumbar anesthesia and epidural anesthesia.The anesthetic effects of the two groups were compared,and the hemodynamic changes,stress response and agitation rate of patients in each period were monitored.Results:There were no significant differences in the spontaneous breathing recovery time,extubation time,speech response time,eye opening time and directional force recovery time between the two groups(P>0.05).The blood oxygen saturation(SpO_(2)),mean arterial pressure(MAP)and heart rate in the two groups immediately after tracheal tube insertion(T1),10 min after operation(T2)and 10 min after extubation(T3)were lower than those at T0(P<0.05),while the SpO_(2),MAP and heart rate in the observation group at T1,T2 and T3 were lower than those in the control group(P<0.05).The contents of norepinephrine(NE)and cortisol(COR)in both groups were increased at 10min after operation,30min after operation and 24h after operation compared with those before operation(P<0.05),while the contents of NE and COR in observation group were lower than those in control group at 10min after operation,30 min after operation and 24 h after operation(P<0.05).The agitation rate in the observation group was lower than that in the control group at 6 h,24 h and 48 h after operation,with statistical significance(P<0.05).Conclusion:General anesthesia with laryngeal mask ventilation and combined lumbar and epidural anesthesia have similar anesthetic effects in ureteroscopic holmium laser lithotripsy,but general anesthesia with laryngeal mask ventilation is more conducive to stabilizing hemodynamics,reducing stress response and better sedation effect.