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目的:探讨经皮肾穿刺取石术中三种麻醉方法的优缺点。方法:在581例经皮肾穿刺取石术中采用全身麻醉(全麻)62例,均为一期手术;椎管内阻滞麻醉(椎麻)442例,437例为一期手术,5例为二期手术;局部浸润麻醉(局麻)77例,32例为一期手术,45例为二期手术。结果:使用全麻者术中均较舒适,但术后有2例发生严重的呼吸障碍,胸腹腔引流出大量液体。椎麻者俯卧位手术时间较长,时有不同程度的不适感,22例主动要求停止手术,其中侧卧位患者则无明显不适感。局麻者手术时间短,均顺利完成手术。结论:在经皮肾穿刺取石术中,全麻没有比较性优势;在体位的配合下,椎麻可以满足所有患者;对于比较单纯的肾结石及第三腰椎以上的输尿管结石,局麻也能满意解决。随着结石体积的减小、技术的提高及碎石工具的改进,可以预见局麻下经皮肾镜取石术将会得到更广泛的应用。
Objective: To investigate the advantages and disadvantages of three anesthetic methods in percutaneous nephrolithotomy. Methods: 581 patients undergoing percutaneous nephrolithotomy were treated with general anesthesia (general anesthesia), 62 cases were operated on for one time. 442 patients underwent spinal block anesthesia (vertebral anesthesia), 437 patients underwent primary surgery and 5 patients For the second surgery; local infiltration anesthesia (local anesthesia) in 77 cases, 32 cases of a surgery, 45 cases for the second phase of surgery. Results: The use of general anesthesia were more comfortable surgery, but after 2 cases of severe respiratory disorders, chest and abdominal drainage of large amounts of liquid. Vertebral prostheses prone position surgery for a long time, when there are varying degrees of discomfort, 22 cases were asked to stop surgery, including the lateral position was no obvious discomfort. Local anesthesia operation time is short, have successfully completed the operation. Conclusion: In percutaneous nephrolithotomy, general anesthesia has no comparative advantage. With the cooperation of body position, vertebral hemakinensis can meet all patients. For simple renal calculi and ureteral calculi above the third lumbar vertebra, local anesthesia can also Satisfied with the solution. With the reduction of the volume of stones, the improvement of technology and the improvement of lithotripsy tools, it is foreseeable that percutaneous nephrolithotomy under local anesthesia will be more widely used.