【摘要】 目的:观察比较硬膜外麻醉(EA)和腰麻-硬膜外联合麻醉(CSEA)两种麻醉方法,用于输尿管镜及气压弹道碎石器行经尿道输尿管镜下碎石术(URL)的麻醉效果及并发症,探讨尿道输尿管镜下碎石手术的麻醉方法。方法:选择ASAⅠ-Ⅱ级、年龄18岁～65岁拟行尿道输尿管镜下碎石术的患者80例,随机分为腰麻—硬膜外联合麻醉和硬膜外麻醉两组;每组40例,采用针刺法测定麻醉平面,观察两组病例用药量、起效时间,上升到各个麻醉平面上界的时间及麻醉效果;术中患者出现低血压、寒战、术后头痛、腰背痛发生率。结果:腰麻硬膜外联合麻醉组的起效时间、麻醉平面上升时间均比硬膜外麻醉组快,且用药量少(P<0.01),两组低血压、术后头痛、腰背痛发生率差异无显著性(P>0.05),寒战发生率腰麻硬膜外联合麻醉组小于硬膜外麻醉组(P<0.01)。结论:腰麻硬膜外联合麻醉麻醉方式有起效快、效果确切、副作用小的优点,是尿道输尿管镜下碎石手术较好的麻醉方法之一。更多还原

【Abstract】 Objective To compare the effects and complications of epidural anesthesia(EA) and combined sinal and epidural anesthesia(CSEA) for trans-urethral ureteroscope lithotripsy(URL), and to discuss anesthesia methods for URL.Methods Eighty ASA physical status Ⅰand Ⅱpatients 18~65 years of age, scheduled for URL, were randomized into group CSEA(n=40) and group EA (n=40).Pin-prick method was employed to determine anesthesia level, and local anesthetic dosage, onset time, time to attain optimal anesthesia level and anesthesia effect were recorded. Hypotension, shiver, post-operative headache and lumbodorsal pain were observed.Results Compared to group EA, group CSEA showed more rapid onset and shorter time to attain optimal anesthesia level with more little local anesthetic(P<0.01). There is not any significant difference in hypotension, post-operative headache and lumbodorsal pain between the two groups (P>0. 05), incidence of shiver was lower in group CSEA than in group EA (P<0.01).Conclusions CSEA is an optimal method for URL for its rapid onset, securely effect and little complication.更多还原