联合腰麻硬膜外麻醉或全凭静脉麻醉用于经皮肾镜碎石术

发布时间：2018-05-07 11:43

本文选题：麻醉 + 静脉　；参考：《重庆医学》2015年02期

【摘要】：目的观察和评价联合腰麻硬膜外麻醉(CSEA)及全凭静脉麻醉(TIVA)用于经皮肾镜碎石术的麻醉效果。方法选择64例行经皮肾镜碎石术的患者行回顾性分析,分为CSEA组和TIVA组两组,每组32例。记录两组入手术室时(基础值,t0)、改变体位为俯卧位或半侧卧位时(t1)、切皮时(t2)、出手术室时(t3),以及CSEA组腰部麻醉后15min时(tSA 15min)和TIVA组气管插管时(ti)的收缩压(SBP)、舒张压(DBP)、心率(HR)等,观察麻醉效果、输液量、术中使用麻黄碱和阿托品、CSEA组局麻药用量、手术时间、手术期间或出室时患者不适发生率,以及不良事件等。结果 t0时两组血压和HR差异无统计学意义(P0.05),CSEA组患者在t1、t2、t3时的SBP、DBP和MAP均低于t0(P0.05),t1和t3时的HR高于t0(P0.05);TIVA组患者在t1和t2时的SBP、DBP、MAP和HR均低于t0(P0.05),但t3时的SBP、DBP和MAP均高于t0(P0.05)。t1和t2时CSEA组SBP和HR均高于TIVA组,而t3时CSEA组SBP和DBP均低于TIVA组(P0.05)。术后CSEA患者不适发生率为6.3%,低于TIVA组的25.0%(P0.05)。结论 CSEA和TIVA均可用于经皮肾镜碎石术,CSEA术中舒适度低,但术后舒适度更高;结石较小,手术时间短、一般情况好的患者采用CSEA可能较好,反之采用全身麻醉可能较好。
[Abstract]:Objective to observe and evaluate the effect of combined spinal epidural anesthesia (CSEAA) and total intravenous anesthesia (TIVA) on percutaneous nephrolithotripsy. Methods Sixty-four patients undergoing percutaneous nephrolithotripsy were retrospectively analyzed and divided into two groups: CSEA group and TIVA group with 32 cases in each group. Systolic blood pressure (SBP), diastolic pressure (DBP), heart rate (HRR) were recorded in the two groups when they entered the operating room (basic value was t 0, change position was in prone position or half lateral position, t2n was in skin incision, and TSA was 15 min after 15min after lumbar anaesthesia in CSEA group) and in TIVA group, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HRT) were recorded when the patients were in the operation room after lumbar anaesthesia, and in the TIVA group, the systolic blood pressure (SBP) and diastolic pressure (DBP) were recorded. The effect of anesthesia, the volume of infusion, the dosage of ephedrine and atropine CSEA during the operation, the time of operation, the incidence of discomfort during the operation and the adverse events were observed. Results there was no significant difference in blood pressure and HR between the two groups at t 0 time. The SBP DBP and MAP of CSEA group were lower than that of T0 P0 P0 05 T1 and T3 group at t 1 and t 2, but the MAP and SBP DBP in t 1 and t 2 group were higher than those in t 0 P 2 group and map HR were lower than that in t 1 and t 2 group respectively. However, the MAP and MAP in t 3 group were higher than those in T 0 P 2 group and T 3 group. Both SBP and HR in CSEA group were higher than those in TIVA group at t 2. At t 3, SBP and DBP in CSEA group were lower than that in TIVA group (P 0.05). The incidence of discomfort in patients with CSEA after operation was 6. 3%, which was lower than that of 25. 0% in TIVA group (P 0. 05). Conclusion both CSEA and TIVA can be used in percutaneous nephrolithotripsy for patients with lower comfort, but higher postoperative comfort. CSEA may be better for patients with small stones and short operation time, whereas general anesthesia may be better.
【作者单位】：广州军区武汉总医院麻醉科;
【分类号】：R614

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