1、临床医学研究与实践2023 年 4 月第 8 卷第 12 期Comparison of the effects of microchannel percutaneous nephrolithotomy surgeryunder local anesthesia and general anesthesia in the treatment ofrenal calculi and upper ureteral calculiWANG Wenqiang1,SUN Lin2*(1.Tongchuan Mining Bureau Central Hospital,Tongchuan 727000;2.
2、Sun Si Miao Hospital of BUCM/Traditional Chinese MedicineHospital of Tongchuan,Tongchuan 727100,China)ABSTRACT:Objective To compare the effects of microchannel percutaneous nephrolithotomy surgery under localanesthesia and general anesthesia in the treatment of renal calculi and upper ureteral calcu
3、li.Methods From January toDecember 2020,90 patients with renal calculi and upper ureteral calculi treated by microchannel percutaneousnephrolithotomy surgery in the urinary surgery department of our hospital were selected as the research objects.According todifferent anesthesia methods,the patients
4、were divided into control group(45 cases,general anesthesia)and observationgroup(45 cases,local anesthesia).The therapeutic effects of the two groups were compared.Results There was no significantdifference in the anesthetic effect between the two groups(P0.05).There were no significant differences
5、in operation timeand hospital stay between the two groups(P0.05);the total incidence of postoperative adverse reactions in the observationgroup was lower than that in the control group,and the difference was statistically significant(P0.05).At 1 d after operation,the levels of interleukin-6(IL-6),in
6、terleukin-8(IL-8)and tumor necrosis factor-(TNF-)in the observation group werelower than those in the control group,and the differences were statistically significant(P0.05).At 1 d after operation,thelevels of 2-microglobulin(2-M),creatinine(Cr)and blood urea nitrogen(BUN)in the observation group we
7、re lower thanthose in the control group,and the differences were statistically significant(P0.05);at 7 d after operation,the levels of Crand BUN in the observation group were lower than those in the control group,and the differences were statisticallysignificant(P0.05).Conclusion Microchannel percut
8、aneous nephrolithotomy surgery under local anesthesia in the treatment of renal calculi andupper ureteral calculi has a good effect,it is conducive to improving inflammatory and renal function indicators levels,andhas a low incidence of adverse reactions,which is worthy of clinical promotion.KEYWORD
9、S:local anesthesia;general anesthesia;microchannel percutaneous nephrolithotomy surgery;renal calculi;upper ureteral calculi局麻与全麻下微通道经皮肾镜取石术治疗肾结石及输尿管上段结石的效果比较王文强1,孙林2*(1.铜川矿务局中心医院,陕西 铜川,727000;2.北京中医药大学孙思邈医院/铜川市中医医院,陕西 铜川,727100)DOI:10.19347/ki.2096-1413.202312014作者简介:王文强(1980),男,副主任医师。研究方向:泌尿系结石。*通
10、讯作者:孙林,E-mail:.摘要:目的 比较局麻与全麻下微通道经皮肾镜取石术治疗肾结石及输尿管上段结石的效果。方法 选择 2020 年 1 月至 12 月本院泌尿外科收治的 90 例采用微通道经皮肾镜取石术治疗肾结石及输尿管上段结石患者作为研究对象,根据麻醉方式不同将其分为对照组(45 例,全身麻醉)和观察组(45 例,局部麻醉)。比较两组的治疗效果。结果 两组的麻醉效果比较,差异无统计学意义(P0.05)。两组的手术时间、住院时间比较,差异无统计学意义(P0.05);观察组的术后不良反应总发生率低于对照组,差异具有统计学意义(P0.05)。术后 1 d,观察组的白细胞介素-6(IL-6)、
11、白细胞介素-8(IL-8)、肿瘤坏死因子-(TNF-)水平低于对照组,差异具有统计学意义(P0.05)。术后 1 d,观察组的 2-微球蛋白(2-M)、血肌酐(Cr)、血尿素氮(BUN)水平低于对照组,差异具有统计学意义(P0.05);术后 7 d,观察组的 Cr、BUN 水平低于对照组,差异具有统计学意义(P0.05)。两组的净石率比较,差异无统计学意义(P0.05)。结论 局麻下微通道经皮肾镜取石术治疗肾结石及输尿管上段结石患者的效果较好,有利于改善炎症指标及肾功能指标水平,且不良反应发生率低,值得临床推广。关键词:局部麻醉;全身麻醉;微通道经皮肾镜取石术;肾结石;输尿管上段结石中图分类号
12、:R699.2文献标志码:A文章编号:2096-1413(2023)12-0051-04临床医学肾结石和输尿管上段结石是临床常见的泌尿系统结石。随着外科技术的发展,多数肾结石、输尿管结石采用微51-临床医学研究与实践2023 年 4 月第 8 卷第 12 期通道经皮肾镜取石术、输尿管软管取石术等微创手术进行治疗,均能有效清除结石,其中微通道经皮肾镜取石术应用最为广泛,效果理想1。在上述手术治疗中通常采用全身麻醉,以保证充分氧供和完善镇痛、肌松效果,但存在麻醉费用较高、易发生机体失代偿、术后并发症较多等缺点2。局部麻醉相对安全,符合当前加速康复外科理念要求,能够在镇痛的同时更好地保护心肺功能,术
13、后肠麻痹和手术应激发生率较低。目前,国内已有关于局部麻醉在微通道经皮肾镜取石术中的应用报道,刘建和等3报道局麻成功率达 98.9%,净石率为 89.5%。目前鲜有比较全麻和局麻对微通道经皮肾镜取石术患者净石效果、并发症等影响的相关报道。基于此,本研究选择 2020 年 1 月至 12 月本院泌尿外科收治的 90 例行微通道经皮肾镜取石术治疗肾结石及输尿管上段结石患者作为研究对象,比较局麻与全麻下微通道经皮肾镜取石术治疗肾结石及输尿管上段结石的效果,现将具体内容报道如下。1 资料与方法1.1 一般资料选择 2020 年 1 月至 12 月本院泌尿外科收治的 90 例采用微通道经皮肾镜取石术治疗肾
14、结石及输尿管上段结石患者作为研究对象,根据麻醉方式不同将其分为对照组和观察组,各 45 例。对照组男 29 例,女 16 例;年龄 2968 岁,平均(45.468.65)岁;肾结石 32 例,输尿管上段结石 13 例;结石直径 1.25.6 cm,平均(3.560.95)cm;合并肾功能不全 4 例,肾积脓 1 例。观察组男 31 例,女 14 例;年龄 2969 岁,平均(45.598.74)岁;肾结石 34 例,输尿管上段结石 11 例;结石直径 1.35.7 cm,平均(3.680.92)cm;合并肾功能不全 6 例,肾积脓 2 例。两组患者的一般资料比较,差异无统计学意义(P0.05
15、),具有可比性。本研究经医院伦理委员会批准;所有患者均知情同意且自愿签署知情同意书。1.2 纳入及排除标准纳入标准:经影像学检查确诊为肾结石或输尿管上段结石4;具有微通道经皮肾镜取石术手术指征;术前无明显泌尿系统感染或者脓毒血症等感染性疾病。排除标准:合并心、肾等重要脏器严重功能不全;合并全身出血性疾病以及凝血功能异常;合并泌尿生殖道肿瘤;术前 34 周内服用抗凝血药物导致凝血异常。1.3 方法对照组采用全身麻醉。给予静脉推注 12 mg/kg 丙泊酚乳状注射液(厂家:江苏恩华药业股份有限公司;批准文号:国药准字 H20123138;规格:20 mL0.2 g)、0.1 mg/kg 注射用维库
16、溴铵(厂家:宜昌人福药业有限责任公司;批准文号:国药准字 H20133079;规格:4 mg)、510 g/kg 枸橼酸舒芬太尼注射液厂家:江苏恩华药业股份有限公司;批准文号:国药准字 H20203652;规格:5 mL250 g(按C22H30N2O2S 计)进行麻醉诱导,待成功后进行气管插管、机械通气并保持潮气量在 810 mL/kg,微泵注射丙泊酚和注射用盐酸瑞芬太尼厂家:宜昌人福药业有限责任公司;批准文号:国药准字 H20030199;规格:2 mg(按C20H28N2O5计)维持麻醉。观察组采用局部麻醉。术前 30 min 肌注 100 mg 盐酸哌替啶注射液(厂家:宜昌人福药业有限责任公司;批准文号:国药准字 H42022074;规格:2 mL100 mg)、25 mg 盐酸异丙嗪注射液(厂家:通化华夏药业有限责任公司;批准文号:国药准字 H20053042;规格:2 mL50 mg)。患者进入手术室后采取膀胱截石位,向尿道推注 10 mL 1%盐酸利多卡因注射液(厂家:邯郸康业制药有限公司;批准文号:国药准字 H13021218;规格:5 mL50 mg),术中明确穿刺点