腰麻-硬膜外联合麻醉及全凭静脉麻醉用于经皮肾镜碎石术的麻醉效果比较  

Comparison of anesthetic effect between combined spinal epidural anesthesia and total intravenous anesthesia in percutaneous nephrolithotomy

作　　者：利鸿胜[1] 彭丽云[1] 

机构地区：[1]广东省茂名市人民医院麻醉手术科,广东茂名525000

出　　处：《中国医药科学》2016年第7期178-181,共4页China Medicine And Pharmacy

摘　　要：目的探讨在经皮肾镜碎石术中,分别采用腰麻-硬膜外联合麻醉和全凭静脉麻醉的临床麻醉作用效果。方法选取80例经皮肾镜碎石患者在我院接受治疗的患者,以随机数字表法将患者分成两组,实行腰麻-硬膜外联合麻醉方法设为A组,实行全凭静脉麻醉方法为B组。观察两组患者麻醉前后血压、心率的变化情况、临床麻醉效果以及不良反应发生率。结果在麻醉前,A组患者的血压、心率、血氧饱和度与B组相比没有明显差异;在Tb、Tc、Td、Te时,A组患者的血压、心率、血氧饱和度与B组相比明显较低;在Tf时,A组患者的血压、心率、血氧饱和度与B组相比明显较高;A组患者的麻醉起效时间(25.46±8.48)s、总阻滞时间(15.34±5.11)min、苏醒时间(14.34±4.78)min与B组患者的麻醉起效时间(38.56±12.88)s、总阻滞时间(10.45±3.15)min、苏醒时间(19.56±6.88)min相比具有显著差异;A组患者不良反应如温度过低、苏醒延迟以及心动过缓的发生率显著低于B组的,差异具统计学意义(P<0.05)。结论经皮肾镜碎石术采用CSEA方法可以缩短临床麻醉起效和苏醒时间,降低临床不良反应的发生,是临床麻醉的首选方式。对于临床手术条件较差和手术时间延长的患者TIVA更适宜。Objective To compare the anesthetic effect between combined spinal epidural anesthesia and total intravenous anesthesia in percutaneous nephrolithotomy（PCNL）. Methods 80 patients who received PCNL in our hospital were randomly divided into group A and group B. The group A received CSEA, and the group B received TIVA. The blood pressure, heart rates, and adverse reaction ratios of the two groups before and after anesthesia were compared. Results Before anesthesia, the blood pressure, heart rates, and adverse reaction ratio of the group A were not obviously different with those of the group B. At Tb,Tc,Td,and Te, the blood pressure,heart rates,and blood oxygen saturation of the group A were obviously lower than those of the group B,while at Tf,the blood pressure, heart rates, and blood oxygen saturation of the group A were obviously higher than those of the group B. The anesthesia onset time（25.46±8.48）s,total blocking time（15.34±5.11）min, and recovery time（14.34±4.78）min of the group A were obviously different with those of group B, which were（38.56±12.88）s,（10.45±3.15）min, and（19.56±6.88）min respectively.The incidence of adverse reactions, such as low temperature, recovery delay,and bradycardia of the group A were obviously lower than those of the group B, the differences were statistically significant（P〈0.05）. Conclusion The employment of CSEA in the PCNL can shorten the anesthesia onset time and recovery time, meanwhile decrease the adverse reaction rate, which is the first choice in the clinical anesthesia.The TIVA is more suitable for the patients with prolonged operation time or poor surgery conditions.

关 键 词：经皮肾镜碎石术 腰麻-硬膜外联合麻醉 全凭静脉麻醉 麻醉效果 

分 类 号：R614[医药卫生—麻醉学]