潘国全

[摘要]目的 探讨局麻经皮肾镜下碎石取石术（PCNL）在基层医院上尿路结石患者中的应用。方法 选取2018年5月～2020年3月我院收治的60例上尿路结石患者作为研究对象，按照随机数字表法分组方法分为对照组（30例）与研究组（30例）。对照组采用腰-硬联合麻醉下行PCNL治疗，研究组采用局麻下行PCNL治疗。比较两组患者的手术指标、肾功能指标以及疼痛分级。结果 研究组患者的手术时间、肾造瘘管留置时间、住院时间短于对照组，结石清除率高于对照组，差异均有统计学意义（P<0.05）。术前，两组患者的血尿素氮（BUN）、肌酐（Cr）水平比较，差异无统计学意义（P>0.05）;术后，研究组患者的BUN、Cr水平均低于对照组，差异有统计学意义（P<0.05）。两组患者的疼痛程度比较，差异无统计学意义（P>0.05）。结论 在基层医院开展局麻PCNL治疗上尿路结石患者，能缩短患者的手術时间和住院时间，提高结石清除率，进而改善患者的肾功能，具有较高的可行性，值得在基层医院推广应用。

[关键词]局麻;经皮肾镜下碎石取石术;基层医院;上尿路结石;临床效果

[中图分类号] R699.2          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0091-04

Application of local anesthesia percutaneous nephroscope lithoipsy in patients with upper urinary tract calculi in grass-roots hospitals

PAN Guo-quan

Department of Surgery， People′s Hospital of Qingcheng District in Qingyuan City， Guangdong Province， Qingyuan   511500， China

[Abstract] Objective To explore the application of local anesthesia percutaneous nephroscope lithoipsy （PCNL） in patients with upper urinary tract calculi in grass-roots hospitals. Methods A total of 60 patients with upper urinary tract calculi admitted to our hospital from May 2018 to March 2020 were selected as the research objects. They were divided into control group （30 cases） and study group （30 cases） according to the random grouping method. The control group was treated with PCNL under combined spinal and epidural anesthesia， and the study group was treated with PCNL under local anesthesia. The surgical index， renal function index and pain grade of the two groups of patients were compared. Results The operation time， indwelling time and hospitalization time of the patients in the study group were shorter than those of the control group， and the stone clearance rate was higher than that of the control group， the differences were statistically significant （P<0.05）. Before surgery， there were no significant differences in blood urea nitrogen （BUN） and creatinine （Cr） between the two groups （P>0.05）. After surgery， BUN and Cr levels were lower than those in the control group， and the differences were statistically significant （P<0.05）. There was no statistically significant difference in the degree of pain between the two groups （P>0.05）. Conclusion Carrying out local anesthesia PCNL in grass-roots hospitals to treat patients with upper urinary tract calculi can shorten the operation time and hospitalization time of patients， improve the stone clearance rate， and thus improve the renal function of patients. It is worthy of popularization and application in grass-roots hospitals.

[Key words] Local anesthesia; Percutaneous nephroscope lithoipsy; Grass-roots Hospitals; Upper urinary tract calculi; Clinical effect

上尿路结石[1]是泌尿外科常见的疾病，随着医学技术的发展，临床上多让患者接受经皮肾镜下碎石取石术（percutaneous nephroscope lithoipsy，PCNL）治疗，手术前可采用局麻、全麻或腰-硬联合麻醉，但是患者手术时采用全麻或腰-硬联合麻醉后不良反应较多，部分患者的麻醉清醒时间较长，且严重影响术后预后效果，甚至有些患者无法耐受麻醉风险，或存在担忧、恐惧的心理，进而影响手术麻醉效果，故选择一种安全有效的麻醉方式对患者十分重要[2-3]。局麻相对于其他麻醉而言，患者的疼痛耐受度較好，且手术预后效果较佳，有效促进手术的顺利进行。……