摘要
目的探讨行经皮肾镜钬激光碎石术的患者术中发生不良反应的原因及麻醉管理对策。方法记录385例已择期行经皮肾镜碎石术的患者的一般情况,ASA分级,麻醉方式,手术体位及开始时至术毕每30min为观察时间点的心率、血压、呼吸频率、脉搏氧饱和度,手术时间、灌流液总量、术中出现的不良反应及麻醉处理方法。将术中发生不良反应的68例患者分为A组(观察组),无不良反应的317例为B组(对照组)并进行统计学分析。结果两组手术时间、灌流液总量无差异;A组平均年龄及体质量较B组大但比较差异无统计学意义;A组术前合并症明显多于B组(P<0.05);A组手术至60mim血压明显高于手术开始时(P<0.05),但与B组比较差异无统计学意义。不良反应主要发生在手术进行60min后,以椎管内麻醉及俯卧位发生率高,经对症处理后明显好转,2例患者无好转终止手术治疗。结论不同麻醉方式下行经皮肾镜钬激光碎石术中均有不良反应发生,原因与术前患者的合并症、麻醉方式、手术体位、手术时间及灌注液总量有关,临床上应根据患者个体情况选择不同麻醉方式,尽量缩短手术时间,降低术中灌注压,以减少灌洗液的吸收。
Objective To investigate the reason of side-effects and anesthesia management in percutaneous neplrolithotripsy （PCNI.）. Methods Totally 385 cases of patients were treated with PCNL and the date concerning general state of health, ASA Grade,anesthesia methods,operation time,body position, the changes of HR,BP,RR, SpO2 in the operation, irrigation volume and the treatments of all side-effects were reviewed retrospectively. All patients were assigned to side-effects group （group A,n= 68） and non-side-effects group（group B,n=317） according to presence or absence of adverse reaction during operation. Results Neither operation time or irrigation volume difference was found in two groups, average age and body weight were slightly higher in group A than those in group B. complication before operation remarkably appeared in group A compared with that in group B, BP significantly increased al 60min after the beginning of the operation than that before operation. Side-effects principally appeared af ter 60min after the beginning of the operation, especially patients undergoing intravertebral anesthesia or supine position and eliminated after clinical trcatments,except two cases. Conclusion Occurrence of side effects in patients undergoing PCNL by different anesthesia methods correlated with complications before operation,anesthesia managements, body position,operation time and irrigation volume. Therefore, careful preparation, corrective anesthesia methods, low pressure irrigation during operation and early diagnosis and treatment are the effective ways to decrease the occurrence of side-effect in PCNL.
出处
《重庆医学》
CAS
CSCD
2008年第17期1911-1912,1915,共3页
Chongqing medicine
