[1]孙 硕.腰麻联合硬膜外麻醉与全身麻醉在输尿管软镜肾结石钬激光碎石术中的有效性和安全性[J].医学信息,2023,36(20):121-124.[doi:10.3969/j.issn.1006-1959.2023.20.023]
　SUN Shuo.Efficacy and Safety of Combined Spinal-epidural Anesthesia and General Anesthesia in Ureteroscopic Holmium Laser Lithotripsy for Renal Calculi[J].Journal of Medical Information,2023,36(20):121-124.[doi:10.3969/j.issn.1006-1959.2023.20.023]
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腰麻联合硬膜外麻醉与全身麻醉在输尿管软镜肾结石钬激光碎石术中的有效性和安全性()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年20期
页码:
121-124
栏目:
论著
出版日期:
2023-10-15

文章信息/Info

Title:
Efficacy and Safety of Combined Spinal-epidural Anesthesia and General Anesthesia in Ureteroscopic Holmium Laser Lithotripsy for Renal Calculi
文章编号:
1006-1959（2023）20-0121-04
作者:
孙 硕
（佳木斯市中心医院麻醉科，黑龙江 佳木斯 154002）
Author(s):
SUN Shuo
(Department of Anesthesia,Jiamusi Central Hospital,Jiamusi 154002,Heilongjiang,China)
关键词:
腰麻联合硬膜外麻醉; 全身麻醉; 输尿管软镜; 肾结石
Keywords:
Combined spinal-epidural anesthesia; General anesthesia; Ureteroscope; Renal calculi
分类号:
R692.4
DOI:
10.3969/j.issn.1006-1959.2023.20.023
文献标志码:
A
摘要:
目的 比较腰麻联合硬膜外麻醉与全身麻醉在输尿管软镜肾结石钬激光碎石术中的有效性和安全性。方法 选取2019年4月-2022年1月我院诊治的98例肾结石患者为研究对象，采用随机数字表法分为对照组（n=49）和观察组（n=49）。所有患者予以输尿管软镜肾结石钬激光碎石治疗，对照组采用腰麻联合硬膜外麻醉，观察组采用全身麻醉，比较两组生命体征[平均动脉压、血压、心率、血氧饱和度（SpO2）]、疼痛评分、临床手术指标（手术时间、输入液体总量）、不良反应发生率。结果 两组术中平均动脉压、收缩压、舒张压、SpO2均低于术前，且观察组高于对照组（P＜0.05）；两组术中、术后疼痛评分均低于术前（P＜0.05），但观察组与对照组不同时间段疼痛评分比较，差异无统计学意义（P＞0.05）；观察组手术时间、输入液体总量均小于对照组（P＜0.05）；观察组不良反应发生率为6.12%，低于对照组的18.37%（P＜0.05）。结论 腰麻联合硬膜外麻醉与全身麻醉在输尿管软镜肾结石钬激光碎石术中可实现基本相似的镇痛作用，但全身麻醉术中对患者血压、心率、平均动脉压、SpO2影响较小，且可降低麻醉期间不良反应，缩短手术时间，减少输入液体量，具有更优的安全性。
Abstract:
Objective To observe the efficacy and safety of combined spinal-epidural anesthesia and general anesthesia in ureteroscopic holmium laser lithotripsy for renal calculi.Methods A total of 98 patients of renal calculi diagnosed and treated in our hospital from April 2019 to January 2022 were selected as the research object, and were randomly divided into control group (n=49) and observation group (n=49) according to random number table. All patients were treated with ureteroscopic holmium laser lithotripsy, while the control group was treated with combined spinal-epidural anesthesia, while the observation group was treated with general anesthesia. The vital signs [mean arterial pressure, blood pressure, heart rate, oxygen saturation (SpO2)], pain score, clinical operation indexes (operation time, total amount of fluid input) and incidence of adverse reactions were compared between the two groups.Results The mean arterial pressure, systolic pressure, diastolic pressure and SpO2 intraoperative in both groups were lower than those before operation, and those in the observation group were higher than the those in control group (P<0.05). The pain scores during and after operation in both groups were lower than those before operation (P<0.05), but there was no statistical difference between the observation group and the control group at different time periods (P>0.05). The operation time and total amount of fluid input in the observation group were shorter than those in the control group (P<0.05). The incidence of adverse reactions in the observation group was 6.12%, which was lower than 18.37% in the control group (P<0.05).Conclusion Combined spinal-epidural anesthesia and general anesthesia can achieve similar analgesic effect in ureteroscopic holmium laser lithotripsy, but general anesthesia has little effect on patients’ blood pressure, heart rate, average arterial pressure and SpO2. Meanwhile, it can reduce adverse reactions during anesthesia, shorten operation time and reduce the amount of fluid input, which has better safety.

参考文献/References:

[1]任昌,安瑞华.输尿管软镜碎石术与经皮肾镜碎石术治疗直径2～4cm肾结石的疗效比较[J].临床与病理杂志,2018,38(11):2421-2426.[2]李永洪.探讨经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石的临床效果观察[J].中外医学研究,2018,16(19):35-37.[3]王勇,黄兴,周洪益,等.输尿管软镜和经皮肾镜碎石治疗肾结石的效果对比[J].宁夏医科大学学报,2018,40(1):71-74.[4]席俊华,张艳斌,吴畏,等.同期与分期单通道经皮肾镜取石术联合输尿管软镜钬激光碎石术治疗复杂性肾结石的对比研究[J].国际泌尿系统杂志,2020,40(1):72-75.[5]谢海龙,关超,谷明利,等.电子输尿管软镜联合钬激光治疗肾、输尿管上段结石的效果观察[J].蚌埠医学院学报,2017,41(5):619-622.[6]尹随,李樊,邓豫,等.非气管插管麻醉在胸腔镜肺叶切除术中的应用对比研究[J].中国胸心血管外科临床杂志,2019,26(1):57-62.[7]刘林海,汪勇,张仰,等.组合式输尿管软镜联合钬激光碎石术与经皮肾镜碎石术治疗肾结石对比研究[J].微创泌尿外科杂志,2019,8(4):247-251.[8]皇甫佳文,颜伟,张菊根,等.经皮肾镜碎石术与输尿管软镜治疗肾结石的临床疗效对比研究[J].河北医学,2017,22(10):1683-1685.[9]杨帆,段予民,郭坤乾,等.局麻与全麻下输尿管软镜钬激光碎石术治疗肾结石的效果比较[J].徐州医科大学学报,2018,38(12):803-805.[10]喻平,叶波林,曾金稳,等.不同麻醉方法在输尿管镜钬激光碎石效果[J].中国医药科学,2018,8(7):152-154.[11]程渊,章巍,张红,等.经支气管镜钬激光碎石在支气管结石患者治疗中的应用[J].中华结核和呼吸杂志,2017,40(1):29-33.[12]周菁,周坤,马燕,等.输尿管镜钬激光碎石术中右美托咪定的麻醉镇静效果分析[J].实用临床医药杂志,2016,20(13):163-164.[13]赵春利,周可义,杨文增,等.经皮微通道同期治疗肾盂旁囊肿合并肾盂输尿管连接部狭窄的疗效观察[J].中国微创外科杂志,2017,17(9):808-810.[14]李灿永.经皮肾镜碎石取石术与输尿管软镜钬激光碎石术治疗肾结石的效果分析[J].现代诊断与治疗,2019,30(15):2665-2667.[15]Lange B,Cordes J,Brinkmann R.Stone /tissue differentiation for hol mium laser lithotripsy using autofluorescence[J].Lasers Surg Med,2018,47(9):737-744．[16]辜敏,汪海洋,黄翠源,等.七氟烷与丙泊酚减轻碎石术后炎症反应的效果比较[J].西南国防医药,2017,27(11):1222-1224.[17]苏继英.喉罩全麻在输尿管钬激光碎石中的临床应用效果评价[J].基层医学论坛,2017,21(35):4952-4954.[18]彭汉新,龚楚链,陈潮金,等.不同麻醉方法下输尿管软镜钬激光碎石术治疗肾结石的比较[J].中华腔镜泌尿外科杂志(电子版),2018,12(1):31-34.[19]陈磊,谢栋栋,丁德茂,等.输尿管软镜联合钬激光治疗孤立肾肾结石疗效[J].安徽医学,2017,38(7):864-866.[20]李爱群,车吉忠.输尿管软镜下钬激光治疗肾结石效果观察[J].山东医药,2017,57(18):78-80.

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更新日期/Last Update: 1900-01-01