局麻联合强化麻醉下微创经皮肾镜术治疗上尿路结石的临床研究  

Clinical study of minimally invasive percutaneous nephrolithotomy under local anesthesia combined with intensive anesthesia in the treatment of upper urinary tract calculi

作　　者：郑金华[1] 谢进东[1] 陈景宇[1] 黄永萍[1] Zheng Jinhua;Xie Jindong;Chen Jingyu;Huang Yongping(Department of Urology,the First People's Hospital of Huizhou,Guangdong 516000,China)

机构地区：[1]惠州市第一人民医院泌尿外科

出　　处：《中华腔镜泌尿外科杂志（电子版）》2019年第4期263-266,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨局麻结合强化麻醉对比全麻下微创经皮肾输尿管镜取石术(MPCNL)治疗上尿路结石的临床效果。方法选取2015年12月至2017年12月间在惠州市第一人民医院择期进行MPCNL手术的上尿路结石患者98例,依据随机数字表法将其分成两组,对照组(49例)患者采取全麻,观察组(49例)患者采取局麻结合强化麻醉;观察患者手术时间、住院时间、双J管留置时间、结石清除率、肾造瘘管留置时间、术后不良反应状况,术前1 d与术后3 d患者血清尿素氮(BUN)、C-反应蛋白(CRP)、血肌酐(Cr)、肿瘤坏死因子α(TNF-α)、β2-微球蛋白(β2-M)及白细胞介素6(IL-6)浓度改变状况。结果观察组患者手术时间、住院时间低于对照组,差异有统计学意义(P<0.05),两组患者结石清除率、双J管留置时间和肾造瘘管留置时间差异无统计学意义(P>0.05);术后3 d两组患者血清CRP、TNF-α及IL-6浓度较术前1 d显著升高,差异有统计学意义(P<0.05),观察组升高幅度低于对照组,两组患者术后3 dβ2-M、Cr及BNU浓度和术前1 d对比3 d两组间对比差异均无统计学意义(P>0.05);观察组总的不良反应发生率为14.29%,低于对照组的30.61%,差异有统计学意义(P<0.05)。结论局麻联合强化麻醉下进行MPCNL术可有效降低患者术后不良反应、血清炎症反应及住院时间,但在病例选择上需谨慎,术前准备与术中监护工作要做充分。Objective To analyze the effect of local anesthesia combined with intensive anesthesia on minimally invasive percutaneous nephrolithotomy(MPCNL)in treatment of patients with upper urinary tract calculi.Methods 98 patients with upper urinary calculi who underwent MPCNL in Huizhou First People’s Hospital from December 2015 to December 2017 were randomly divided into two groups according to the random number table method.The control group(49 patients)were taken genera anesthesia,the observation group(49 patients)underwent local anesthesia combined with anesthesia.The patient’s operation time,hospital stay,double J tube indwelling time,stone clearance rate,renal fistula indwelling time,postoperative adverse reaction status,and serum urea nitrogen(BUN),C-reactive protein(CRP),serum creatinine(Cr),tumor necrosis factor alpha(TNF-α),β2-microglobulin(β2-M),interleukin 6(IL-6)one day before and 3 days after surgery.Results The operation time and hospitalization time of the observation group were lower than those of the control group(P<0.05).There was no significant difference between the two groups in stone removal rate,double J tube indwelling time and renal fistula indwelling time(P>0.05).The levels of serum CRP,TNF-αand IL-6 3 days after operation in the two groups were significantly higher than those in the 1 day before operation(P<0.05).The increase in the observation group was lower than that in the control group.There were no significant differences in the levels ofβ2-M,Cr and BNU between the two groups on the 1 day before surgery and 3 days after operation(P>0.05).The total adverse reaction rate in the observation group was 14.29%,which was lower than the control group of 30.61%(P<0.05).Conclusion MPCNL under local anesthesia combined with intensive anesthesia can effectively reduce postoperative adverse reactions,serum inflammatory response and hospitalization time,but caution should be taken in case selection,preoperative preparation and intraoperative monitoring should be sufficient.

关 键 词：经皮肾镜 尿路结石 局部麻醉 全麻 前瞻性研究 

分 类 号：R699[医药卫生—泌尿科学]