高危老年肾结石的一期经皮肾镜治疗  

Percutaneous nephrolithotomy treats renal calculi in high-risk aged patients under local anaesthesia

作　　者：陈小刚[1] 张青汉[1] 王瑜[1] 桂定文[1] 彭伟[1] 

机构地区：[1]湖北省黄石市中心医院泌尿外科,湖北黄石435000

出　　处：《中国内镜杂志》2011年第1期28-30,共3页China Journal of Endoscopy

摘　　要：目的探讨合并心、肺等功能障碍的高危老年肾结石患者在局部麻醉下行一期经皮肾镜碎石(PC-NL)的安全性及有效性。方法回顾性总结2006年2月～2009年12月该科治疗的60例高危老年肾结石患者的临床资料。20例合并慢支肺气肿,15例合并高血压,5例合并心功能不全,15例合并糖尿病,5例合并肾功能不全,术前ASA分级均≥3级。手术均一期在局部麻醉下行经皮肾镜碎石或取石术。应用视觉模拟评分法(VAS)评估患者耐受程度。监测患者麻醉前、麻醉后20 min、术后血压(BP)、心率(HR)、血氧饱和度(SaO2)、血氧分压(PaO2)、血二氧化碳分压(PaCO2)变化。结果 60例手术一期均顺利完成。手术时间平均(75±10)min,VAS评分平均(3.4±0.7)分,术中与麻醉前、麻醉后20 min比较,BP增加10～20 mmHg,HR增加5～10 bpm,SaO2、PaO2、PaCO2无变化。结论对于选择性的合并心、肺、肾等功能障碍高危因素的老年肾结石患者,采用局部麻醉下行一期经皮肾取石术方法疗效确切,同时明显降低了手术风险,是一种值得推荐的方法。【Objection】To study the clinical experiences of the percutaneous nephrolithotomy（PCNL） treatment on renal calculi under local anesthesia for high-risk patients.【Methods】In this study 60 with renal calculus from 2006/02 to 2009/12 were collected.They all underwent mini-percutaneous nephrolithotomy under local anesthesia.20 patients are with Chronic bronchitis emphysema,15 with high-risk hypertension,5 with cardiac insufficiency,15 with diabetes and 5 with renal insufficiency.All patients had an anesthesia risk with American Society of Anesthesi-ologists（ASA） grade 3 or above.Pain scores were measured using 10cm linear visual analogue scale（VAS） after the completion of both procedures.BP,HR,SaO2,PaO2,PaCO2 of all patients were tested in preanesthesia,postanesthe-sia in 20min and intraoperation,respectively.【Results】there were 60 cases performed with single-tract PCNL in first stage under local anesthesia.No major complications were noted in all patients.Compared with preanesthesia and postanesthesia in 20 min,BP,HR was increased 10～20 mmHg,5～10 times per min,respectively and SaO2,PaO2,PaCO2 were no significant change in the operation.【Conclusions】PCNL under local anesthesia is safe,effec-tive and convenient,especially for high-risk patients intolerant with anesthesia.

关 键 词：肾结石 微创经皮肾镜取石术 局部麻醉 高危 

分 类 号：R692.4[医药卫生—泌尿科学]