中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
3期
22-24
,共3页
麻醉,全身%碎石术%椎管内麻醉
痳醉,全身%碎石術%椎管內痳醉
마취,전신%쇄석술%추관내마취
Anesthesia,general%Lithotripsy%Intraspinal anesthesia
目的 比较全身麻醉与椎管内麻醉下经皮肾穿刺碎石术(PCNL)患者循环、呼吸、体温的变化以及麻醉恢复期相关并发症的发生情况,以评价麻醉效果与安全性.方法 ASA分级Ⅰ～Ⅱ级择期行PCNL患者40例,按随机数字表法分为气管内插管全身麻醉组(Ⅰ组)和椎管内麻醉组(Ⅱ组),每组20例.记录两组患者的体温、心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)的变化及恢复期不良反应发生情况.结果 Ⅰ组麻醉过程平稳,各时间点MAP、心率无明显变化;Ⅱ组麻醉效果确切,但麻醉后15 min的MAP及截石位后、俯卧位后的心率和MAP均较麻醉前和Ⅰ组有明显变化(P＜0.05).两组患者麻醉后30、60、90、120min的体温均较麻醉即刻有不同程度的下降(P＜0.05),且Ⅰ组患者麻醉后30、60min体温[(35.8±0.6)、(34.8±0.5)℃]明显低于Ⅱ组[(36.2±0.6)、(35.6±0.5)℃](P＜0.05).两组患者麻醉恢复期寒战、恶心、咽痛、背部不适均有发生,其中以发生寒战者最多.结论 两种麻醉方式均适用于PCNL;椎管内麻醉下术中需严密观察患者的各项生命指标;而对于肥胖、体质较弱、呼吸循环代偿功能较差的患者宜选用气管内插管全身麻醉.
目的 比較全身痳醉與椎管內痳醉下經皮腎穿刺碎石術(PCNL)患者循環、呼吸、體溫的變化以及痳醉恢複期相關併髮癥的髮生情況,以評價痳醉效果與安全性.方法 ASA分級Ⅰ～Ⅱ級擇期行PCNL患者40例,按隨機數字錶法分為氣管內插管全身痳醉組(Ⅰ組)和椎管內痳醉組(Ⅱ組),每組20例.記錄兩組患者的體溫、心率、平均動脈壓(MAP)、脈搏血氧飽和度(SpO2)的變化及恢複期不良反應髮生情況.結果 Ⅰ組痳醉過程平穩,各時間點MAP、心率無明顯變化;Ⅱ組痳醉效果確切,但痳醉後15 min的MAP及截石位後、俯臥位後的心率和MAP均較痳醉前和Ⅰ組有明顯變化(P＜0.05).兩組患者痳醉後30、60、90、120min的體溫均較痳醉即刻有不同程度的下降(P＜0.05),且Ⅰ組患者痳醉後30、60min體溫[(35.8±0.6)、(34.8±0.5)℃]明顯低于Ⅱ組[(36.2±0.6)、(35.6±0.5)℃](P＜0.05).兩組患者痳醉恢複期寒戰、噁心、嚥痛、揹部不適均有髮生,其中以髮生寒戰者最多.結論 兩種痳醉方式均適用于PCNL;椎管內痳醉下術中需嚴密觀察患者的各項生命指標;而對于肥胖、體質較弱、呼吸循環代償功能較差的患者宜選用氣管內插管全身痳醉.
목적 비교전신마취여추관내마취하경피신천자쇄석술(PCNL)환자순배、호흡、체온적변화이급마취회복기상관병발증적발생정황,이평개마취효과여안전성.방법 ASA분급Ⅰ～Ⅱ급택기행PCNL환자40례,안수궤수자표법분위기관내삽관전신마취조(Ⅰ조)화추관내마취조(Ⅱ조),매조20례.기록량조환자적체온、심솔、평균동맥압(MAP)、맥박혈양포화도(SpO2)적변화급회복기불량반응발생정황.결과 Ⅰ조마취과정평은,각시간점MAP、심솔무명현변화;Ⅱ조마취효과학절,단마취후15 min적MAP급절석위후、부와위후적심솔화MAP균교마취전화Ⅰ조유명현변화(P＜0.05).량조환자마취후30、60、90、120min적체온균교마취즉각유불동정도적하강(P＜0.05),차Ⅰ조환자마취후30、60min체온[(35.8±0.6)、(34.8±0.5)℃]명현저우Ⅱ조[(36.2±0.6)、(35.6±0.5)℃](P＜0.05).량조환자마취회복기한전、악심、인통、배부불괄균유발생,기중이발생한전자최다.결론 량충마취방식균괄용우PCNL;추관내마취하술중수엄밀관찰환자적각항생명지표;이대우비반、체질교약、호흡순배대상공능교차적환자의선용기관내삽관전신마취.
Objective To compare the influences of general anesthesia and intra spinal anesthesia on circulation, respiration, body temperature and anesthesia-related complications in patients undergoing percutaneous nephrolithotomy (PCNL), and assess the effectiveness and safety of both anesthesia. Methods Forty ASA Ⅰ - Ⅱ patients elective for PCNL surgery were divided into two groups by random digits table with 20 cases each:group Ⅰ (endotracheal general anesthesia) and group Ⅱ (intra spinal anesthesia). The temperature, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) values and postoperative shivering, nausea, vomiting, back discomfort and the incidence of sore throat were observed and recorded. Results The anesthesia was stable, there were no changes in MAP, HR at different time in group Ⅰ . The anesthesia in group Ⅱ was effective, MAP at 15 min after anesthesia,and HR,MAP after lithotomy position and prone position were obviously changed in group Ⅱ compared with those before anesthesia and group Ⅰ (P ＜ 0.05 ). The temperature at 30,60,90, 120 min after anesthesia decreased compared with that before anesthesia in two groups (P ＜ 0.05 ), and the temperature at 30,60 min after anesthesia in group Ⅰ [(35.8 ±0.6), (34.8 ± 0.5)℃] was lower than that in group Ⅱ [(36.2 ± 0.6),(35.6 ± 0.5)℃](P＜ 0.05).During recovery,complications such as shivering, nausea,sore throat, back discomfort occurred to some extent, of which the incidence of shivering was the highest. Conclusion Both of two anesthesia are applicable to PCNL. When intra spinal anesthesia is used,the life indicators of patients need to be observed and general anesthesia is preferable for the obesity,less physical and the old with poorly compensatory function.
