持续硬膜外麻醉与全麻行经皮肾镜取石手术效果比较(1)
摘 要：目的 研究对经皮肾镜取石术患者实施持续硬膜外麻醉与全身麻醉的临床效果，比较两种方式的安全性。方法 选择2016年4月～12月在本院接受经皮肾镜取石手术治疗的患者60例，将其随机分成观察组和对照组，各30例。观察组患者接受持续硬膜外麻醉，对照组患者接受全身麻醉，比较两组患者麻醉后平均动脉压(MAP)、呼吸频率(RR)、心率(HR)、血氧饱和度(SpO2)、中心静脉压(CVP)等指标，同时观察两组并发症发生情况。结果 观察组中患者的MAP、RR、HR、SpO2及CVP等水平均优于对照组，差异有统计学意义(P<0.05)，观察组并发症发生率低于对照组(13.33% vs 33.33%)，差异有统计学意义(P<0.05)。结论 临床上针对经皮肾镜取石手术患者可以运用持续硬膜外麻醉的形式，其操作简单，安全性高，对患者造成的影响小，术后并发症率低，值得临床推广。
关键词：经皮肾镜取石；全身麻醉；持续硬膜外麻醉
中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.07.039
, http://www.100md.com
文章编号：1006-1959(2018)07-0118-02
Comparison of Percutaneous Nephrolithotomy between Continuous Epidural Anesthesia and General Anesthesia
SHEN Ying
(Department of Anesthesiology，Sichuan Lithiasis Hospital，Chengdu 610000，Sichuan，China)
Abstract：Objective To study the clinical effects of continuous epidural anesthesia and general anesthesia in patients undergoing percutaneous nephrolithotomy and compare the safety of the two methods.Methods 60 patients undergoing percutaneous nephrolithotomy from April to December 2016 were randomly divided into two groups：the observation group and the control group with 30 cases each.The patients in the observation group received continuous epidural anesthesia，while the patients in the control group received general anesthesia.The mean arterial pressure(MAP)，respiratory frequency(RR)，heart rate(HR)，blood oxygen saturation(SPO2) and central venous pressure(CVP)were compared between the two groups.Complications were observed in both groups.Results The levels of MAP，RR，HR，SpO2 and CVP in the observation group were higher than those in the control group，the difference was statistically significant(P<0.05).The incidence of complications in the observation group was lower than that in the control group (13.33%vs33.33%)，the difference was statistically significant(P<0.05).Conclusion Continuous epidural anesthesia can be used in patients undergoing percutaneous nephrolithotomy.It is easy to operate，has high safety，has little influence on patients，and has low postoperative complications，so it is worth popularizing.
, http://www.100md.com
Key words：Percutaneous nephrolithotomy；General anesthesia；Continuous epidural anesthesia
针对肾结石以及输尿管上段结石症状，在目前临床上最为常见也是最重要的治疗方法为经皮肾镜取石术(percutaneous nephroscope lithoipsy，PCNL)。这种手术法现已有完全取代开放手术的趋势[1]。持续硬膜外麻醉能够保留患者意识，使其及时配合手术变换体位。全身麻醉患者则在变化体位时存在困难，特别是在俯卧位下使得呼吸道管理比较困难。本次研究对2016年4月～12月来我院接受治疗的60例肾结石以及输尿管上段结石的患者，对其分别采取全身麻醉以及连续硬膜外麻醉手术，分析两种麻醉效果，现报告如下。
1 資料与方法
1.1一般资料 选择2016年4月～12月在四川结石病医院接受经皮肾镜取石手术患者60例。经本院医学伦理委员会审批通过，按照随机数字表法将其分成观察组和对照组，各30例。纳入标准：①患者或家属对本次研究知情同意；②经肾盂造影、彩超检查，确诊为结石；③符合手术适应证。排除标准：①合并先天性心脏病者；②严重肝肾功能不全等严重疾病无法耐受手术者，合并肾盂肿瘤者；③有手术禁忌证者。观察组中男18例，女12例，年龄25～65岁，平均年龄(47.15±5.28)岁，其中肾结石13例，输尿管上段结石10例，肾结石合并输尿管上段结石7例，ASAⅠ～Ⅱ期；对照组中男16例，女14例，年龄26～66岁，平均年龄(49.22±6.46)岁，其中肾结石14例，输尿管上段结石11例，肾结石合并输尿管上段结石5例，ASAⅠ～Ⅱ期。两组患者的一般资料比较差异无统计学意义(P>0.05)，临床可比。, http://www.100md.com(申英)
关键词：经皮肾镜取石；全身麻醉；持续硬膜外麻醉
中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.07.039
, http://www.100md.com
文章编号：1006-1959(2018)07-0118-02
Comparison of Percutaneous Nephrolithotomy between Continuous Epidural Anesthesia and General Anesthesia
SHEN Ying
(Department of Anesthesiology，Sichuan Lithiasis Hospital，Chengdu 610000，Sichuan，China)
Abstract：Objective To study the clinical effects of continuous epidural anesthesia and general anesthesia in patients undergoing percutaneous nephrolithotomy and compare the safety of the two methods.Methods 60 patients undergoing percutaneous nephrolithotomy from April to December 2016 were randomly divided into two groups：the observation group and the control group with 30 cases each.The patients in the observation group received continuous epidural anesthesia，while the patients in the control group received general anesthesia.The mean arterial pressure(MAP)，respiratory frequency(RR)，heart rate(HR)，blood oxygen saturation(SPO2) and central venous pressure(CVP)were compared between the two groups.Complications were observed in both groups.Results The levels of MAP，RR，HR，SpO2 and CVP in the observation group were higher than those in the control group，the difference was statistically significant(P<0.05).The incidence of complications in the observation group was lower than that in the control group (13.33%vs33.33%)，the difference was statistically significant(P<0.05).Conclusion Continuous epidural anesthesia can be used in patients undergoing percutaneous nephrolithotomy.It is easy to operate，has high safety，has little influence on patients，and has low postoperative complications，so it is worth popularizing.
, http://www.100md.com
Key words：Percutaneous nephrolithotomy；General anesthesia；Continuous epidural anesthesia
针对肾结石以及输尿管上段结石症状，在目前临床上最为常见也是最重要的治疗方法为经皮肾镜取石术(percutaneous nephroscope lithoipsy，PCNL)。这种手术法现已有完全取代开放手术的趋势[1]。持续硬膜外麻醉能够保留患者意识，使其及时配合手术变换体位。全身麻醉患者则在变化体位时存在困难，特别是在俯卧位下使得呼吸道管理比较困难。本次研究对2016年4月～12月来我院接受治疗的60例肾结石以及输尿管上段结石的患者，对其分别采取全身麻醉以及连续硬膜外麻醉手术，分析两种麻醉效果，现报告如下。
1 資料与方法
1.1一般资料 选择2016年4月～12月在四川结石病医院接受经皮肾镜取石手术患者60例。经本院医学伦理委员会审批通过，按照随机数字表法将其分成观察组和对照组，各30例。纳入标准：①患者或家属对本次研究知情同意；②经肾盂造影、彩超检查，确诊为结石；③符合手术适应证。排除标准：①合并先天性心脏病者；②严重肝肾功能不全等严重疾病无法耐受手术者，合并肾盂肿瘤者；③有手术禁忌证者。观察组中男18例，女12例，年龄25～65岁，平均年龄(47.15±5.28)岁，其中肾结石13例，输尿管上段结石10例，肾结石合并输尿管上段结石7例，ASAⅠ～Ⅱ期；对照组中男16例，女14例，年龄26～66岁，平均年龄(49.22±6.46)岁，其中肾结石14例，输尿管上段结石11例，肾结石合并输尿管上段结石5例，ASAⅠ～Ⅱ期。两组患者的一般资料比较差异无统计学意义(P>0.05)，临床可比。, http://www.100md.com(申英)