3次回抽注入法腰硬联合麻醉在经皮肾镜碎石手术中的应用*

周志红

(江西省萍乡市湘东区人民医院 萍乡 337016)

*萍乡市2014年市级指导性科技计划项目，项目编号：2014NS069

摘 要目的：探讨3次回抽注入法腰硬联合麻醉在经皮肾镜碎石手术中的应用效果。方法：选择我院收治的在腰硬联合麻醉下行经皮肾镜碎石手术患者160例，随机分为实验组和对照组各80例。实验组患者采用一点穿刺3次回抽注入法腰硬联合麻醉，对照组患者采用传统两点穿刺腰硬联合麻醉。观察比较两组患者的麻醉效果。结果：实验组患者达到Bromage评分2分、3分时间及穿刺操作总时间均明显短于对照组，差异有统计学意义（P＜0.05）；5～10 min时，实验组患者DBP与SBP的下降幅度小于对照组同时间点，差异有统计学意义（P＜0.05）；两组患者的穿刺成功率与置管成功率及麻醉期间不良反应的发生率比较，差异无统计学意义（P＞0.05）。结论：3次回抽注入法腰硬联合麻醉在经皮肾镜手术中具有损伤小、安全性高、镇痛效果好、操作更简单、血流动力学稳定，更便于围术期管理的优势。

关键词3次回抽注入法 腰硬联合麻醉 经皮肾镜

Application of three withdrawing waist hard joint anesthesia injection method in percutaneous nephroscope lithotripsy surgery*

ZHOU Zhihong

(The People’s Hospital of Xiangdong District, Pingxiang City, Pingxiang 337016, China)

ABSTRACTObjective: To investigate the application effect of the three withdrawing waist hard joint anesthesia injection method on percutaneous nephroscope lithotripsy surgery. Methods: One hundred and sixty cases of patients performing percutaneous nephroscope lithotripsy surgery under the waist hard joint anesthesia in our hospital were selected and randomly divided into an experimental group and a control group with 80 cases each. The point puncture three withdrawing waist hard joint anesthesia injection method was adopted in the experimental group while only traditional puncture waist hard joint anesthesia in the control group. The anesthesia effect was observed between two groups. Results: The times for reaching Bromage score 2 or 3 points and the total time required for puncture operation were significantly shorter in the experimental group than in the control group (P＜0.05). The decline of SBP and DBP at 5～10 min was less in the experimental group than in the control group (P＜0.05). The success rates for puncture and catheterization and the incidence of adverse reactions during anesthesia had no statistically significant difference (P＞0.05). Conclusion: Three withdrawing waist hard joint anesthesia injection method during percutaneous nephroscope surgery has some advantages such as less injury, higher safety, better analgesia effect, simpler operation, more stable hemodynamics, easier perioperative management.

KEY WORDSthree withdrawing ；waist hard joint anesthesia；percutaneous nephroscope

近年来，随着科学技术的进步，肾结石的治疗已进入微创时代。经皮肾镜碎石取石术（PCNL）是治疗巨大、复杂性结石的首选术式之一[1]。PCNL既要求有较广泛的麻醉平面，又要求手术过程中变换体位，两者对患者呼吸循环都可能产生一定影响，对麻醉的要求相对更高[2]。随着PCNL的普及，手术操作日益成熟，腰硬联合麻醉

能保证充分的术中镇痛和肌松，患者保持清醒，有利于及时发现异常情况，已经成为PCNL的主要麻醉方式[3]。……