[1]张　刚,李　航,韩　湘,等.局部麻醉与连续硬膜外麻醉在微创经皮肾镜取石术中的应用效果比较[J].新乡医学院学报,2018,35(5):428-431.[doi:10.7683/xxyxyxb.2018.05.019]
　ZHANG Gang,LI Hang,HAN Xiang,et al.Comparison of the effect of local anesthesia and continuous epidural anesthesia in minimally invasive percutaneous nephrolithotomy[J].Journal of Xinxiang Medical University,2018,35(5):428-431.[doi:10.7683/xxyxyxb.2018.05.019]
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局部麻醉与连续硬膜外麻醉在微创经皮肾镜取石术中的应用效果比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年5
页码:
428-431
栏目:
临床研究
出版日期:
2018-05-05

文章信息/Info

Title:
Comparison of the effect of local anesthesia and continuous epidural anesthesia in minimally invasive percutaneous nephrolithotomy
作者:
张　刚; 李　航; 韩　湘; 王建强; 赵刚强
（汉中市人民医院泌尿外科，陕西　汉中　723000）
Author(s):
ZHANG Gang; LI Hang; HAN Xiang; WANG Jian-qiang; ZHAO Gang-qiang
（Department of Urology，Hanzhong People′s Hospital，Hanzhong 723000，Shaanxi Province，China）
关键词:
微创经皮肾镜取石术; 肾结石; 局部麻醉; 连续硬膜外麻醉
Keywords:
minimally invasive percutaneous nephrolithotripsy; kidney stone; local anesthesia; epidural anesthesia
分类号:
R692.4
DOI:
10.7683/xxyxyxb.2018.05.019
文献标志码:
A
摘要:
目的　比较局部麻醉与连续硬膜外麻醉在微创经皮肾镜取石术（MPCNL）中的应用效果。方法　选择2015年7月至2017年7月在汉中市人民医院行MPCNL的肾结石患者200例，根据麻醉方法分为局部麻醉组和硬膜外麻醉组，每组100例。分别于术前、术毕时和术后1周检测2组患者血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、C-反应蛋白（CRP）、β2-微球蛋白（β2-MG）、肌酐（SCr）及尿素氮（BUN）水平，观察2组患者术前、麻醉后即刻、术毕时、术后1 d的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）的变化，记录2组患者的手术时间、术中出血量、住院时间、总住院费用和结石完全清除率。结果　与术前比较，2组患者麻醉后即刻、术毕时的HR显著升高，而MAP和SpO2显著降低（P<0.05）；2组患者术后1 d与术前HR、MAP、SpO2比较差异均无统计学意义（P>0.05）；同一时间点2组患者HR、MAP、SpO2比较差异均无统计学意义（P>0.05）。2组患者手术时间、术中出血量比较差异均无统计学意义（P> 0.05）；局部麻醉组患者住院时间显著短于硬膜外麻醉组，住院费用显著少于硬膜外麻醉组（P<0.05）。局部麻醉组和硬膜外麻醉组患者结石完全清除率分别为94.0%（94/100）、93.0%（93/100），2组患者结石完全清除率比较差异无统计学意义（χ2=0.003，P>0.05）。术前2组患者血清中IL-6、TNF-α、CRP、β2-MG、SCr及BUN水平比较差异均无统计学意义（P>0.05）。2组患者术毕时血清中IL-6、TNF-α、CRP、β2-MG、SCr及BUN水平显著高于术前（P<0.05），2组患者术后1周时血清IL-6、TNF-α、CRP、β2-MG、SCr及BUN水平显著低于术毕时（P<0.05）。术毕时和术后1周时局部麻醉组患者血清中IL-6、TNF-α、CRP水平显著低于硬膜外麻醉组（P<0.05），但2组患者血清中β2-MG、SCr及BUN水平比较差异无统计学意义（P>0.05）。结论　MPCNL中应用局部麻醉和连续硬膜外麻醉均可获得较好的麻醉效果和治疗效果，但局部麻醉成本较低，患者住院时间短，全身炎症反应较轻。
Abstract:
Objective　To compare the effect of local anesthesia and continuous epidural anesthesia in minimally invasive percutaneous nephrolithotomy （MPCNL）.Methods　A total of 200 patients with kidney stone who underwent MPCNL were selected from July 2015 to July 2017 in Hanzhong People′s Hospital.The patients were divided into local anesthesia group and epidural anesthesia group according to the anesthetic method，with 100 cases in each group.The levels of serum interleukin-6（IL-6），tumor necrosis factor-α（TNF-α），C-reactive protein （CRP），β2-microglobulin （β2-MG），serum creatinine （SCr） and blood urea nitrogen （BUN） of the patients in the two groups were detected at the time points of before operation，postoperative instant and one week after operation.The changes of heart rate （HR），mean arterial pressure （MAP） and pulse oxygen saturation （SpO2） of the patients in the two groups were observed at the time points of before operation，postanesthetic instant，postoperative instant and one day after operation.The operation time，intraoperative bleeding volume，hospitalization time，the total hospitalization cost and the stone complete clearance rate were recorded in the two groups.Results　Compared with before operation，the HR was significantly increased，while the MAP and SpO2 were significantly decreased at the time points of postanesthetic instant and postoperative instant in the two groups （P<0.05）.There was no significant difference in HR，MAP and SpO2 between pre-operation and one day after operation in the two groups （P>0.05）.There was no significant difference in HR，MAP，SpO2 between the two groups at the same time point （P>0.05）.There was no significant difference in the operation time and intraoperative bleeding volume between the two groups （P>0.05）.The hospitalization time in the local anesthesia group was significantly shorter than that in the epidural anesthesia group，and the hospitalization cost was significantly less than that in the epidural anesthesia group （P<0.05）.The stone complete clearance rate in the local anesthesia group and epidural anesthesia group was 94.0% （94/100） and 93.0% （93/100） respectively，and there was no significant difference in the stone complete clearance rate between the two groups （χ2=0.003，P>0.05）.There was no significant difference in the levels of serum IL-6，TNF-α，CRP，β2-MG，SCr and BUN between the two groups before operation （P>0.05）.The levels of serum IL-6，TNF-α，CRP，β2-MG，SCr and BUN at the end of the operation were significantly higher than those before operation in the two groups （P<0.05）.The levels of serum IL-6，TNF-α，CRP，β2-MG，SCr and BUN at one weeks after operation were significantly lower than those at the end of the operation in the two groups （P<0.05）.The levels of serum IL-6，TNF-α and CRP in the local anesthesia group were significantly lower than those in the epidural anesthesia group at the end of the operation and one week after operation（P<0.05）；but there was no significant difference in the levels of serum β2-MG，SCr and BUN between the two groups （P>0.05）.Conclusion　Local anesthesia and epidural anesthesia can achieve better anesthetic effect and therapeutic effect in MPCNL，but the cost of local anesthesia is low，the hospitalization time of patients is short and the systemic inflammatory response of patients is mild.

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更新日期/Last Update: 2018-05-05