【摘要】 目的 探讨腰方肌阻滞联合全身麻醉在经皮肾镜碎石术（PCNL）中的应用效果。方法 选取73例择期行PCNL的肾结石患者作为观察对象，采用随机数字表法分为联合组（37例）和对照组（36例）。2组患者均常规进行麻醉前准备，对照组实施静脉全身麻醉，联合组实施腰方肌阻滞联合静脉全身麻醉。比较2组患者入室麻醉前（T0）、麻醉诱导后10 min（T1）、建立经皮肾镜碎石通道时（T2）、手术30 min（T3）、手术结束时（T4）、术后30 min（T5）的生命体征相关指标[血氧饱和度（SpO₂）、心率（HR）、平均动脉压（MAP）]、麻醉质量相关指标（丙泊酚和术后48 h内舒芬太尼用量、术后排气时间、术后住院时间）、术后视觉模拟量表（VAS）评分及不良反应发生情况。结果 SpO₂组间、时间点、交互比较差异均无统计学意义（P>0.05）;HR组间、时间点、交互比较差异均有统计学意义（P<0.05）,MAP仅时间点比较差异有统计学意义（P<0.05）;联合组T3时HR与对照组比较差异有统计学意义（P<0.05）。联合组丙泊酚和术后48 h内舒芬太尼用量均低于对照组，术后排气时间和术后住院时间均短于对照组，差异有统计学意义（P<0.05）。2组患者术后各时间点的VAS评分比较差异有统计学意义（P<0.05）,均呈先增加后减少的趋势，且联合组术后6 h、12 h、24 h、48 h的VAS评分均低于对照组，差异有统计学意义（P<0.05）。联合组术后不良反应总发生率为13.51%,对照组为36.11%,2组比较差异有统计学意义（P<0.05）。结论 腰方肌阻滞联合全身麻醉对行PCNL的肾结石患者的生命体征影响更小，可有效提高麻醉质量，减轻术后疼痛程度，降低术后不良反应的发生率，安全性好，有利于促进患者术后恢复。更多还原

【Abstract】 Objective To explore the application effects of quadratus lumborum block combined with general anesthesia in percutaneous nephrolithotomy（PCNL）.Methods A total of 73 patients with renal stones underwent elective PCNL were selected as the observation subjects, and they were divided into the combination group（37 cases） and the control group（36 cases） according to the random number table method. Patients in both groups were routinely prepared for anesthesia, patients in the control group received intravenous general anesthesia and patients in the combination group received quadratus lumborum block combined with intravenous general anesthesia. The vital signs-related indicators [blood oxygen saturation（SpO₂）,heart rate（HR）,mean arterial pressure（MAP）] before entering the room for anesthesia（T0）,10 minutes after anesthesia induction（T1）,when establishing percutaneous nephrolithotomy channel（T2）,30 minutes during surgery（T3）,at the end of surgery（T4） and 30 minutes after surgery（T5）,anesthesia quality-related indicators（dosage of propofol and dosage of sufentanil within 48 hours after surgery, postoperative exhausting time, postoperative hospital stay）,postoperative visual analogue scale（VAS） score and incidence of adverse reactions were compared between two groups.Results There was no significant difference in SpO₂ between groups, time points or interactions（P>0.05）;there were statistically significant differences in HR between groups, time points and interactions（P<0.05）,and there was significant difference in MAP at different time points（P<0.05）;the HR at T3 in the combination group was significantly different from that in the control group（P<0.05）. The dosage of propofol and dosage of sufentanil within 48 hours after surgery in the combination group were lower than those in the control group, and the postoperative exhausting time and postoperative hospital stay were shorter than those in the control group, the differences were statistically significant（P<0.05）. The VAS scores of the two groups at each time points after surgery showed statistically significant differences（P<0.05）,both of which increased first and then decreased, and the VAS scores in the combination group at 6 hours, 12 hours, 24 hours and 48 hours after surgery were lower than those in the control group, the differences were statistically significant（P<0.05）. The total incidence of postoperative adverse reactions in the combination group was 13.51%,while that in the control group was 36.11%,the difference between the two groups was statistically significant（P<0.05）.Conclusion Quadratus lumborum block combined with general anesthesia has less effect on the vital signs of patients with renal stones undergoing PCNL,which can effectively improve the anesthesia quality, relieve the postoperative pain and reduce the incidence of postoperative adverse reactions. It has good safety and is beneficial to promoting the postoperative recovery of patients.更多还原