微创医学

目的比较腰硬联合麻醉（CSEA）和全身麻醉（GA）在经皮肾镜钬激光碎石术（PCNL）中的应用效果。方法选择行经皮肾镜钬激光碎石术的患者100例作为研究对象，随机分为腰硬联合麻醉（CSEA）组和全身麻醉（GA）组各50例，连续监测两组患者收缩压（SBP）、舒张压（DBP）、心率（HR），血氧饱和度（SpO2），分别于手术前（T0）、截石位10 min（T1）、俯卧位10 min（T2）记录各组数据。结果截石位下，手术开始直至改俯卧位前，两组患者循环、呼吸无明显变化。在俯卧位后，CSEA组的血压和心率较手术前均有下降，且差异有统计学意义（P＜0.01）；GA组的变化不大。结论一般情况好、手术准备充分的患者，首选腰硬联合麻醉（CSEA）作为经皮肾镜碎石取石术（PCNL）的麻醉方式。预计手术时间长，患者呼吸、循环差或老年人，则选择全麻，其效果确切、循环干扰小，更显得安全可靠。

ObjectiveTo compare the clinical effects of combined spinal epidural anesthesia (CSEA) and general anesthesia (GA) during percutaneous nephroscopic holmium laser lithotripsy (PCNL). Method100 patients undergoing PCNL were randomly divided into the CSEA group and the GA group, 50 for each. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and blood oxygen saturation (SpO2) were monitored continuously, and the data prior to surgery (T0), in lithotomy position (T1) for 10 min and the prone position for 10 min (T2) were recorded respectively. ResultsBefore surgery, in lithotomy position and during pose changing to prone position, there were no differences between two groups in circulation and breathing. In prone position, the blood pressure and heart rate decreased significantly in CSEA group (P＜0.01), while little change was found in GA group. ConclusionFor those with good physical health and adequate preoperative preparation, CSEA is preferred. For the patients who had long operation duration, with abnormal cardiopulmonary functions or aged patients, GA is better with exact anesthetic effect and less circulation disturbance