全身麻醉与腰部麻醉下标准经皮肾镜取石术治疗肾结石的临床效果
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摘要
目的:探讨全身麻醉与腰部麻醉下标准经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)对治疗肾结石的影响。方法:2017年5月至12月收集中南大学湘雅医学院附属株洲医院行标准经皮肾镜取石术的58例患者,将患者随机分为2组:全身麻醉组及腰部麻醉组。比较两组的基本资料、术中及术后的参数。结果:两组在性别、年龄、结石大小、体重、麻醉分级、手术时间、术后血红蛋白下降、术后发热发生率、术后第2天VAS评分、住院时间、结石清除率方面差异无统计学意义(P>0.05),但全身麻醉组术中低血压发生率显著高于腰部麻醉组,且全身麻醉组术后的第1天的VAS评分(6.47±1.39)显著高于腰部麻醉组(4.51±0.81,P<0.05)。结论:全身麻醉与腰部麻醉下行PCNL治疗肾结石均安全有效,在腰部麻醉下行PCNL治疗肾结石比全身麻醉下行PCNL术中低血压发生率更低、术后疼痛更轻,且住院天数较短。
Objective: To investigate the effect of percutaneous nephrolithotomy(PCNL) on the treatment of kidney stones under general anesthesia and spinal anesthesia. Methods: From May 2017 to December 2017, 58 patients underwent standard percutaneous nephrolithotomy. The patients were randomly divided into 2 groups. The first group was general anesthesia, and the second group was in the PCNL group under spinal anesthesia. The basic data, intraoperative, and postoperative parameters of the 2 groups were compared. Results: There were no significant differences in gender, age, stone size, body weight, anesthesia grade, operation time, postoperative hemoglobin decline, postoperative fever incidence, VAS score on the second postoperative day, mean hospital stay, and stone clearance rate(P>0.05). The incidence of hypotension in the general anesthesia group was significantly higher than that in the spinal anesthesia group, and the VAS score on the first day after the surgery in the general anesthesia group was significantly higher than the spinal anesthesia group(6.47±1.39 vs 4.51±0.81, P<0.05). Conclusion: PCNL is safe and effective in the treatment of renal stones with general anesthesia and spinal anesthesia. PCNL treatment of kidney stones under spinal anesthesia has lower incidence of hypotension, less postoperative pain and shorter hospital stay.
Objective: To investigate the effect of percutaneous nephrolithotomy(PCNL) on the treatment of kidney stones under general anesthesia and spinal anesthesia. Methods: From May 2017 to December 2017, 58 patients underwent standard percutaneous nephrolithotomy. The patients were randomly divided into 2 groups. The first group was general anesthesia, and the second group was in the PCNL group under spinal anesthesia. The basic data, intraoperative, and postoperative parameters of the 2 groups were compared. Results: There were no significant differences in gender, age, stone size, body weight, anesthesia grade, operation time, postoperative hemoglobin decline, postoperative fever incidence, VAS score on the second postoperative day, mean hospital stay, and stone clearance rate(P>0.05). The incidence of hypotension in the general anesthesia group was significantly higher than that in the spinal anesthesia group, and the VAS score on the first day after the surgery in the general anesthesia group was significantly higher than the spinal anesthesia group(6.47±1.39 vs 4.51±0.81, P<0.05). Conclusion: PCNL is safe and effective in the treatment of renal stones with general anesthesia and spinal anesthesia. PCNL treatment of kidney stones under spinal anesthesia has lower incidence of hypotension, less postoperative pain and shorter hospital stay.
引文
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2.王本锋,高魏贞.腰部麻醉和全身麻醉下经皮肾镜手术治疗肾结石的效果比较[J].中国现代医生,2015,53(22):20-22.WANG Benfeng,GAO Weizhen.Effect comparison of percutaneous nephroscopic surgery under lumbar anesthesia and general anesthesia in treatment of kidney stones[J].China Modern Doctor,2015,53(22):20-22.
3.熊焕腾,朱遵伟,曾涛,等.微创经皮肾镜处理多肾盏结石并中重度积水的方法[J].中华腔镜泌尿外科杂志(电子版),2017,11(4):28-31.XIONG Huanteng,ZHU Zunwei,ZENG Tao,et al.Clinical study of calyx calculi treatment in moderate to severe hydronephrosis with multi-calyx calculi with minimally invasive percutaneous nephrolithotomy[J].Chinese Journal of Endourology.Electronic Version,2017,11(4):28-31.
4.廖国栋,俞蔚文,章越龙,等.超微经皮肾镜和输尿管软镜治疗肾下极结石疗效及安全性的对比研究[J].中华泌尿外科杂志,2017,38(9):667-670.LIAO Guodong,YU Weiwen,ZHANG Yuelong,et al.Comparison of efficacy and safety between super-mini-percutaneous nephrolithotomy and flexible reteroscope lithtripsy in the treatment of lower calyx calculus[J].Chinese Journal of Urology,2017,38(9):667-670.
5.Movasseghi G,Hassani V,Mohaghegh MR,et al.Comparison between spinal and general anesthesia in percutaneous nephrolithotomy[J].Anesth Pain Med,2014,4(1):e13871.
6.姚尚龙,王国林.麻醉学[M].北京:人民卫生出版社,2012:339-340.YAO Shanglong,WANG Guolin.Anesthesiology[M].Beijing:People’s Medical Publishing House,2012:339-340.
7.Petrosillo N,Cataldo MA,Pea F.Treatment options for communityacquired pneumonia in the elderly people[J].Expert Rev Anti Infect Ther,2015,13(4):473-485.
8.Singh V,Sinha RJ,Sankhwar SN,et al.A prospective randomized study comparing percutaneous nephrolithotomy under combined spinalepidural anesthesia with percutaneous nephrolithotomy under general anesthesia[J].Urol Int,2011,87(3):293-298.
9.Tangpaitoon T,Nisoog C,Lojanapiwat B.Efficacy and safety of percutaneous nephrolithotomy(PCNL):a prospective and randomized study comparing regional epidural anesthesia with general anesthesia[J].Int Braz J Urol,2012,38(4):504-511.