双层面局部浸润麻醉下行经皮肾镜取石术治疗上尿路结石的麻醉效果  

Anesthetic effects of percutaneous nephrolithotomy for upper urinary calculi under two-plane local anesthesia

作　　者：翟建坡 周宁 王海 李贵忠 满立波 ZHAI Jianpo;ZHOU Ning;WANG Hai;LI Guizhong;MAN Libo(Department of Urology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100096,China)

机构地区：[1]首都医科大学附属北京积水潭医院泌尿外科,北京100096

出　　处：《现代泌尿外科杂志》2024年第12期1051-1054,共4页Journal of Modern Urology

基　　金：北京市卫生健康科技成果和适宜技术推广项目(No.BHTPP2022024)。

摘　　要：目的比较双层面局部浸润麻醉(TPLA)与传统局部浸润麻醉(CLA)在经皮肾镜取石术(PCNL)中的麻醉效果,为临床选择适宜麻醉方式提供参考。方法回顾性分析2013年1月—2023年12月在首都医科大学附属北京积水潭医院接受局部浸润麻醉下PCNL治疗的345例肾或输尿管结石患者的资料。根据麻醉方式不同将患者分为CLA组(n=114)和TPLA组(n=231)。对比两组患者术中的疼痛视觉模拟评分(VAS)、结石清除率和手术并发症发生率等资料。结果两组患者的一般资料差异无统计学意义(P>0.05)。术中麻醉效果对比,在皮肾通道建立时,TPLA组较CLA组的VAS评分更低,差异有统计学意义[(3.2±0.5)分vs.(3.8±0.4)分,P=0.023];而在碎石时,两组的VAS评分差异无统计学意义[(3.3±0.5)分vs.(3.4±0.5)分,P=0.061]。两组的手术时间、结石清除率、血红蛋白下降值、术后住院时间、肾造瘘管拔除时间和DJ管留置时间等方面比较,差异均无统计学意义(P>0.05)。结论两种局部浸润麻醉下PCNL的止痛效果均较好,但相较于CLA,TPLA可以显著减少PCNL术中建立皮肾通道时患者的疼痛感。Objective To Compare the effectiveness of conventional local anesthesia(CLA)and two-plane local anesthesia(TPLA)in percutaneous nephrolithotomy(PCNL)so as to provide reference for clinical selection of appropriate anesthetic methods.Methods Clinical data of 345 patients with renal or ureteral calculi who underwent PCNL under local infiltration anesthesia in our hospital during Jan.2013 and Dec.2023 were retrospectively analyzed.The patients were divided into CLA group(n=114)and TPLA group(n=231)according to anesthetic methods.The intraoperative visual analogue scale(VAS)score,stone-free rate and incidence of complications were compared between the two groups.Results There were no significant differences in the baseline data between the two groups(P>0.05).When the cutaneous and renal channels were established,the VAS score was lower in the TPLA group than in the CLA group[(3.2±0.5)vs.(3.8±0.4),P=0.023].However,there was no significant difference in the VAS score during lithotripsy[(3.3±0.5)vs.(3.4±0.5),P=0.061].There were no significant differences between the two groups in terms of operation time,stone-free rate,hemoglobin drop,postoperative hospital stay,and time to remove nephrostomy tube and DJ tube retention time(P>0.05).Conclusion Both CLA and TPLA can provide good analgesia in PCNL,but TPLA can significantly reduce the pain sensation when the cutaneous and renal channels are established.

关 键 词：局部浸润麻醉 双层面局部浸润麻醉 经皮肾镜取石术 肾结石 输尿管结石 

分 类 号：R692.4[医药卫生—泌尿科学]