经尿道输尿管镜下弹道碎石术的麻醉.docVIP

经尿道输尿管镜下弹道碎石术的麻醉 【摘要】 目的：观察比较硬膜外麻醉（EA）和腰麻硬膜外联合麻醉（CSEA）两种麻醉方法，用于输尿管镜及气压弹道碎石器行经尿道输尿管镜下碎石术（URL）的麻醉效果及并发症，探讨尿道输尿管镜下碎石手术的麻醉方法。方法：选择ASAⅠⅡ级、年龄18岁～65岁拟行尿道输尿管镜下碎石术的患者80例，随机分为腰麻—硬膜外联合麻醉和硬膜外麻醉两组；每组40例，采用针刺法测定麻醉平面，观察两组病例用药量、起效时间，上升到各个麻醉平面上界的时间及麻醉效果；术中患者出现低血压、寒战、术后头痛、腰背痛发生率。结果：腰麻硬膜外联合麻醉组的起效时间、麻醉平面上升时间均比硬膜外麻醉组快，且用药量少(Plt;0. 01)，两组低血压、术后头痛、腰背痛发生率差异无显著性(Pgt;0. 05)，寒战发生率腰麻硬膜外联合麻醉组小于硬膜外麻醉组(Plt;0.01)。结论：腰麻硬膜外联合麻醉麻醉方式有起效快、效果确切、副作用小的优点，是尿道输尿管镜下碎石手术较好的麻醉方法之一。 【关键词】 麻醉； 经尿道输尿管镜下弹道碎石术；讨论 　　Anesthesia for Transurethral Ureteroscope Pneumatic Lithotripsy 　　Abstract：Objective To compare the effects and complications of epidural anesthesia(EA) and combined sinal and epidural anesthesia(CSEA) for transurethral ureteroscope lithotripsy(URL), and to discuss anesthesia methods for URL.Methods Eighty ASA physical status Ⅰand Ⅱpatients 18~65 years of age, scheduled for URL, were randomized into group CSEA(n=40) and group EA (n=40).Pinprick method was employed to determine anesthesia level, and local anesthetic dosage, onset time, time to attain optimal anesthesia level and anesthesia effect were recorded. Hypotension, shiver, postoperative headache and lumbodorsal pain were observed.Results Compared to group EA, group CSEA showed more rapid onset and shorter time to attain optimal anesthesia level with more little local anesthetic(Plt;0.01). There is not any significant difference in hypotension, postoperative headache and lumbodorsal pain between the two groups (Pgt;0. 05), incidence of shiver was lower in group CSEA than in group EA (Plt;0.01).Conclusions CSEA is an optimal method for URL for its rapid onset, securely effect and little complication. 　　Key words：Anesthesia;Transurethral ureteroscope pneumatic lithotripsy; Discussion 　　随着腔道泌尿技术的发展，用输尿管镜及气压弹道碎石器行经尿道输尿管镜下碎石术(URL)得到有力的技术支持。由于URL具有创伤小、恢复快、手术可重复性好的特点，近几年来在临床上得到了广泛的应用。我们选取80例输尿管结石碎石手术分别行硬膜外麻醉(EA)和腰麻—硬膜外联合麻醉(CSEA)，对其临床资料进行了比较。 　　1 资料与方法 　　1.1 一般资料 择期URL术80例，男47例，女33例，年龄18岁～65岁，ASAⅠ级～