不同预防性镇痛治疗方案对输尿管下段结石体外冲击波碎石的影响

Effect of different prophylactic analgesic treatment regimens on extracorporeal shock wave lithotripsy of lower ureteral stones

目的:评估术前不同的预防性镇痛治疗方案对输尿管下段结石体外冲击波碎石的影响,探究其必要性及临床价值,寻找合适的用药方案。方法:回顾性分析在我院2021年1月—2022年6月期间被诊断为单发单侧输尿管结石、术前无症状的行体外冲击波碎石的468例患者资料。根据术前预防性镇痛治疗的方式分为3组,未使用镇痛药物(对照组)147例,予以局部麻醉药物治疗(局麻组)167例,肌肉注射全身性镇痛药物治疗(镇痛组)154例。比较3组冲击波放电次数、可耐受最大能量等级、碎石总能量、术中疼痛程度、首次体外碎石成功率。结果:镇痛组的可耐受最大能量等级、碎石总能量、首次体外碎石成功率、术中疼痛缓解程度均优于局麻组和对照组(P<0.05);局麻组的可耐受最大能量等级、碎石总能量、首次体外碎石成功率优于对照组(P<0.05),但疼痛缓解程度差异无统计学意义(P>0.1)。结论:输尿管下段结石ESWL术前予以预防性镇痛可以减少患者疼痛程度,提高首次ESWL的结石清除率,术前预防性镇痛治疗存在一定的临床应用价值,非甾体类全身镇痛药的效果更加明显。

Objective To evaluate the effects of different preoperative prophylactic analgesic regimens on extracorporeal shock wave lithotripsy of lower ureteral stones,to investigate their necessity and clinical value,and to find the appropriate medication regimen.Methods We retrospectively analyzed the data of a total of 468 patients diagnosed with single unilateral ureteral stone without significant pain who underwent extracorporeal shock wave lithotripsy in our hospital.According to the preoperative prophylactic analgesic treatment,there were three groups:147 cases in the group without analgesic drugs,167 cases in the group treated with local anesthetic drugs,and 154 cases in the group treated with intramuscular systemic analgesic drugs.The number of shock wave discharges,the maximum energy level tolerated,the total lithotripsy energy,the intraoperative pain level,and the success rate of the first extracorporeal lithotripsy were compared among the three groups.Results The tolerable maximum energy level,total lithotripsy energy,the success rate of first extracorporeal lithotripsy,and intraoperative pain relief were better in the general analgesic drug group than in the local anesthetic drug group and the no analgesia group(P<0.05).And the tolerable maximum energy level,total lithotripsy energy,and success rate of first extracorporeal lithotripsy were better in the local anesthetic drug group than in the no analgesia group(P<0.05),but there was no significant difference in pain relief(P>0.1).Conclusion Prophylactic analgesia for ESWL of lower ureteral stones can reduce the pain level and improve the stone-free rate of the first ESWL.Preoperative prophylactic analgesia has some clinical application value,and the effect of nonsteroidal analgesics is more obvious.