经皮肾镜碎石手术的麻醉管理(1)
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[摘要] 目的 总结经皮肾镜碎石手术麻醉管理的经验。 方法 回顾性分析本院2011年10月～2012年4月78例经皮肾镜碎石手术患者的麻醉资料，37例(47.4%)合并1种或2种全身性疾病，ASAⅠ～Ⅱ级。所有患者均采用腰硬联合麻醉，术中常规生命体征监测，包括无创血压(BP)、平均动脉压(MAP)、心率(HR)、心电图(ECG)、脉搏血氧饱和度 (SpO2)。 结果 麻醉后(截石位)、俯卧位后MAP和HR较麻醉前降低，经处理迅速恢复正常。 结论 腰硬联合麻醉对于经皮肾镜碎石手术来说是简单安全的，且术中易于及时发现病情变化。
[关键词] 经皮肾镜碎石；腰硬联合麻醉；手术；管理
[中图分类号] R614 [文献标识码] B [文章编号] 1674-4721(2012)07(b)-0101-02
Percutaneous nephrolithotomy operation anesthesia management
JIANG Yunhui
Department of Anesthesiology, Shunyi Hospital in Beijing, Beijing 101300, China
[Abstract] Objective To summary the anesthesia management experience of percutaneous nephrolithotomy operation. Methods The perioperative data of 78 patients who underwent PCNL in our hospital from October 2011 to April 2012 were analyzed retrospectively. 37 cases (47.4%) combined one or two systemic disease, ASA Ⅰ to Ⅱ. All patients were treated with combined spinal-epidural anesthesia, vital signs were monitored during surgery the noninvasive blood pressure (BP), mean arterial pressure (MAP), heart rate(HR), electrocardiogram (ECG), pulse oximetry (SpO2). Results MAP and HR during lithotomy position and prone position were reduced compared with anesthesia, quickly returned to normal after treatment. Conclusion For surgery by percutaneous renal lithotripsy, the combined spinal-epidural anesthesia is simple and safe, and conducive to timely detection of changes in condition.
[Key words] Percutaneous nephrolithotomy; Combined spinal-epidural anesthesia; Operation; Management
经皮肾镜碎石术是一种新型的微创技术，是上尿路结石的主要手术方式，目前已在国内广泛地开展，该类手术具有对患者创伤小、术后恢复快、住院时间短、结石取出率高等优点，但手术频繁变动体位，而且也需要广泛的麻醉平面[1-2]，使用大量的灌注液，可能引起生命体征的剧烈变化 ......
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