超声引导下胸椎旁神经阻滞与腰硬联合麻醉在经皮肾镜碎石术中的临床疗效比较  

The Comparison of Ultra-sound Guided Thoracic Paravertebral Nerve Block and Combined Spinal-epidural Anesthesia in Percutaneous Nephrolithotomy

作　　者：刘磊[1] 刘经纬[1] 彭思维 

机构地区：[1]湖北省潜江市中心医院麻醉科,433199

出　　处：《临床外科杂志》2017年第10期785-787,共3页Journal of Clinical Surgery

摘　　要：目的比较超声引导下胸椎旁神经阻滞(GT)与腰硬联合麻醉(G)在经皮肾镜碎石术中的临床应用。方法经皮肾镜碎石术病人80例,随机分为两组,GT组40例,采用超声引导下胸椎旁神经阻滞。G组40例,采用腰硬联合麻醉。比较两组病人围术期体位变动时血流动力学变化及术后不良反应及并发症。结果两组病人麻醉效果比较,差异无统计学意义(P>0.05)。G组病人体位变化前平均动脉压为(84±31)mmHg,心率(83±14)次/分,体位变化后分别为(91±33)mmHg和(92±26)次/分,前后比较差异有统计学意义(P<0.05);GT组病人体位变化前平均动脉压为(75±23)mmHg,心率(76±16)次/分,体位变化后分别为(73±26)mmHg和(76±11)次/分,前后比较差异无统计学意义(P>0.05)。GT组病人术后出现头痛、尿潴留各2例,背痛4例;G组病人术后出现头痛22例,尿潴留24例,背痛18例,两组比较差异有统计学意义(P<0.05)。结论超声引导下胸椎旁神经阻滞在经皮肾镜碎石术中麻醉效果好,病人在围术期体位变动时血流动力学稳定,术后并发症少。Objective To compare the anesthetic effect of ultra-sound guided thoracic paravertebral nerve block and combined spinal-epidural anesthesia in percutaneous nephrolithotomy.Methods For 80 patients in our hospital scheduled for percutaneous nephrolithotomy were randomly divided into two groups with 40 cases each.The patients in group GT were given ultra-sound guided thoracic paravertebral nerve block.And the patients in group G were given combined spinal-epidural anesthesia.Observe and compare the aesthesia effects,the hemodynamic changes during body change in perioperative period,adverse reactions after surgery and complications of two groups.Results Anesthetic effects were not significantly different between two groups（P〈0.05）.During body change in perioperative period,the MAP and HR of G group were significantly lower than those of GT group.They had significantly difference（P〈0.05）.The adverse reactions after surgery and complications of two group were significantly different between two groups（P〈0.05）.The number of patients who have headache and urinary retention are apparently more group G than in group GT.Conclusion Ultra-sound guided thoracic paravertebral nerve block for percutaneous nephrolithotomy has significant anesthetic effect.Hemodynamics is stable during body change in perioperative period.And there is less complications after surgery.

关 键 词：超声引导 胸椎旁神经阻滞 腰硬联合麻醉 经皮肾镜碎石术 

分 类 号：R614[医药卫生—麻醉学]