低剂量布比卡因腰硬联合麻醉在老年经皮肾镜碎石术中的效果观察
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摘要
目的:探究低剂量布比卡因腰硬联合麻醉在老年经皮肾镜碎石术中的效果。方法:选择2014年3月—2016年3月拟行经皮肾镜碎石术的老年患者54例,以随机数字表法分为低剂量组和高剂量组,每组27例,低剂量组患者采用盐酸布比卡因注射液1.5 ml腰硬联合麻醉,高剂量组患者采用盐酸布比卡因注射液2.0 ml腰硬联合麻醉。记录两组患者麻醉前(t_0)、截石位10 min(t_1)、俯卧位15 min(t_2)、手术结束(t_3)等各时间节点的收缩压(SBP)、舒张压(DBP)、心率和疼痛视觉模拟评分法(visual analogue scale,VAS)评分,统计术后并发症发生率。结果:两组患者术中血压均先降低后恢复,心率均先升高后降低。t_2时低剂量组患者SBP、DBP降低程度显著低于高剂量组,t_3时低剂量组患者SBP、DBP水平均明显高于高剂量组,差异均有统计学意义(P<0.05);其余时间节点两组患者SBP、DBP的差异无统计学意义(P>0.05)。各时间节点两组患者VAS疼痛评分的差异均无统计学差异(P>0.05)。低剂量组患者术后并发症发生率显著低于高剂量组,差异有统计学意义(P<0.05)。结论:与高剂量布比卡因比较,低剂量布比卡因腰硬联合麻醉对老年经皮肾镜碎石术中血流动力学的影响更小,且安全性高,麻醉镇痛效果好,术后并发症少。
OBJECTIVE: To probe into the efficacy of combined spinal-epidural anesthesia with low dose of bupivacaine in percutaneous nephrolithotomy on elderly patients. METHODS: 54 cases with percutaneous nephrolithotomy on elderly patients from Mar. 2014 to Mar. 2016 were selected and divided into low dose group and high dose group via random number table,with 27 cases each. 1. 5 ml 0. 5% of bupivacaine with combined spinal-epidural anesthesia was adopted in low dose group,and 2. 0 ml 0. 5% of bupivacaine with combined spinal-epidural anesthesia was adopted in high dose group. The SBP,DBP,HR and VAS score at t_0( before anesthesia),t_1( lithotomy position),t_2( prone position),t_3( after operation) of two groups were respectively recorded,and the incidence of complications after operation was statistically analyzed. RESULTS: The patients' blood pressures in both groups were stable after a decrease,and the heart rates were decreasing after an increase. At t_2 time,the SBP and DBP of low dose group were lower than that of high dose group. At t_3 time,the SBP and DBP of low dose group were significantly higher than that of high dose group,with statistically significant difference( P < 0. 05). At other times,the SBP and DBP of two groups had no statistical difference( P > 0. 05). The VAS scores of two groups had no statistical difference( P > 0. 05) at any time.The postoperative complication rate of low dose group was significantly lower than that of high dose group,with statistically significant difference( P < 0. 05). CONCLUSIONS: The combined spinal-epidural anesthesiawith low dose of bupivacaine has smaller effect S on hemodynamic in percutaneous nephrolithotomy on elderly patients than that of high dose of bupivacaine,with higher security and better narcotic analgesic effect and less postoperative complication.
OBJECTIVE: To probe into the efficacy of combined spinal-epidural anesthesia with low dose of bupivacaine in percutaneous nephrolithotomy on elderly patients. METHODS: 54 cases with percutaneous nephrolithotomy on elderly patients from Mar. 2014 to Mar. 2016 were selected and divided into low dose group and high dose group via random number table,with 27 cases each. 1. 5 ml 0. 5% of bupivacaine with combined spinal-epidural anesthesia was adopted in low dose group,and 2. 0 ml 0. 5% of bupivacaine with combined spinal-epidural anesthesia was adopted in high dose group. The SBP,DBP,HR and VAS score at t_0( before anesthesia),t_1( lithotomy position),t_2( prone position),t_3( after operation) of two groups were respectively recorded,and the incidence of complications after operation was statistically analyzed. RESULTS: The patients' blood pressures in both groups were stable after a decrease,and the heart rates were decreasing after an increase. At t_2 time,the SBP and DBP of low dose group were lower than that of high dose group. At t_3 time,the SBP and DBP of low dose group were significantly higher than that of high dose group,with statistically significant difference( P < 0. 05). At other times,the SBP and DBP of two groups had no statistical difference( P > 0. 05). The VAS scores of two groups had no statistical difference( P > 0. 05) at any time.The postoperative complication rate of low dose group was significantly lower than that of high dose group,with statistically significant difference( P < 0. 05). CONCLUSIONS: The combined spinal-epidural anesthesiawith low dose of bupivacaine has smaller effect S on hemodynamic in percutaneous nephrolithotomy on elderly patients than that of high dose of bupivacaine,with higher security and better narcotic analgesic effect and less postoperative complication.
引文
[1]李宁,朱玉霖.经皮肾镜碎石术麻醉方式的选择[J].医学信息,2016,29(20):98-99.
[2]李宁,朱玉霖.不同剂量布比卡因腰硬联合麻醉对老年经皮肾镜碎石术血流动力学的影响[J].医学综述,2015,21(22):4210-4212.
[3]杨丽珠,郭晓健,梁丽莉,等.体外冲击波碎石术治疗马蹄肾结石的临床疗效[J].中华泌尿外科杂志,2016,37(3):206-208.
[4]王宁,杨欢,陈志强.果蝇模型在肾结石研究中的应用进展[J].中华泌尿外科杂志,2016,37(5):398-400.
[5]杜晓红,陈勇,童希忠,等.不同剂量右美托咪定预先给药对大鼠布比卡因心脏毒性的影响[J].临床麻醉学杂志,2014,30(7):689-692.
[6]陈治军,梁玉寿,田玉科.舒芬太尼或芬太尼复合小剂量布比卡因用于老年患者腰麻的效果[J].临床麻醉学杂志,2013,29(4):334-335.
[7]石波,张薇薇,简文亭.盐酸氢吗啡酮复合布比卡因在腰硬联合阻滞剖宫产术中的应用[J].实用医学杂志,2016,32(3):469-471.
[8]汪伟,郁万友,钱燕宁.芬太尼复合小剂量布比卡因腰麻在老年患者下肢手术中的应用[J].临床麻醉学杂志,2013,29(11):1088-1090.
[9]杨柏竹.麻醉方式对老年高血压患者围术期心血管相关指标影响观察[J].中国老年保健医学,2016,14(2):37-38.
[10]李铁军,马飞,曾德茁,等.布比卡因用于硬膜外液体预充的剖宫产术患者腰麻的适宜剂量[J].中华麻醉学杂志,2016,36(2):192-195.
[11]刘中伟,张文保,黎妙芬,等.小剂量布比卡因蛛网膜下腔麻醉联合脊椎麻醉联动快速补液在高龄患者下肢手术中的应用[J].中国现代医学杂志,2016,26(10):67-70.
[12]陶玉娟.左布比卡因联合硬膜外自控镇痛泵在分娩镇痛中的应用优势分析[J].中国地方病防治杂志,2016,31(7):781.
[13]王敏,谢林碧,黄伟文,等.外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术应激反应的影响[J].中国药房,2016,27(2):228-230.
[14]李松,王运贤.剖宫产术后不同镇痛方式对产妇泌乳的影响[J].中国妇产科临床杂志,2016,17(5):456-457.
[15]蒋蕤,张枝刚.腰硬联合麻醉与硬膜外麻醉在高原地区剖宫产手术中的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(4):315-317.
[2]李宁,朱玉霖.不同剂量布比卡因腰硬联合麻醉对老年经皮肾镜碎石术血流动力学的影响[J].医学综述,2015,21(22):4210-4212.
[3]杨丽珠,郭晓健,梁丽莉,等.体外冲击波碎石术治疗马蹄肾结石的临床疗效[J].中华泌尿外科杂志,2016,37(3):206-208.
[4]王宁,杨欢,陈志强.果蝇模型在肾结石研究中的应用进展[J].中华泌尿外科杂志,2016,37(5):398-400.
[5]杜晓红,陈勇,童希忠,等.不同剂量右美托咪定预先给药对大鼠布比卡因心脏毒性的影响[J].临床麻醉学杂志,2014,30(7):689-692.
[6]陈治军,梁玉寿,田玉科.舒芬太尼或芬太尼复合小剂量布比卡因用于老年患者腰麻的效果[J].临床麻醉学杂志,2013,29(4):334-335.
[7]石波,张薇薇,简文亭.盐酸氢吗啡酮复合布比卡因在腰硬联合阻滞剖宫产术中的应用[J].实用医学杂志,2016,32(3):469-471.
[8]汪伟,郁万友,钱燕宁.芬太尼复合小剂量布比卡因腰麻在老年患者下肢手术中的应用[J].临床麻醉学杂志,2013,29(11):1088-1090.
[9]杨柏竹.麻醉方式对老年高血压患者围术期心血管相关指标影响观察[J].中国老年保健医学,2016,14(2):37-38.
[10]李铁军,马飞,曾德茁,等.布比卡因用于硬膜外液体预充的剖宫产术患者腰麻的适宜剂量[J].中华麻醉学杂志,2016,36(2):192-195.
[11]刘中伟,张文保,黎妙芬,等.小剂量布比卡因蛛网膜下腔麻醉联合脊椎麻醉联动快速补液在高龄患者下肢手术中的应用[J].中国现代医学杂志,2016,26(10):67-70.
[12]陶玉娟.左布比卡因联合硬膜外自控镇痛泵在分娩镇痛中的应用优势分析[J].中国地方病防治杂志,2016,31(7):781.
[13]王敏,谢林碧,黄伟文,等.外周神经阻滞与腰-硬联合麻醉对老年高血压患者下肢手术应激反应的影响[J].中国药房,2016,27(2):228-230.
[14]李松,王运贤.剖宫产术后不同镇痛方式对产妇泌乳的影响[J].中国妇产科临床杂志,2016,17(5):456-457.
[15]蒋蕤,张枝刚.腰硬联合麻醉与硬膜外麻醉在高原地区剖宫产手术中的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(4):315-317.