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目的比较两点硬膜外、腰硬联合阻滞和硬膜外复合骶麻用于经输尿管镜钬激光碎石术的效果。方法360例ASAⅠ~Ⅱ级行经输尿管镜钬激光碎石术病人随机分为三组。Ⅰ组两点硬膜外阻滞(CEA)组(n=120),两点法:第10~11胸椎或第11~12胸椎行硬膜外向上置管,再行第3~4腰椎或4~5腰椎硬膜外向下置管。Ⅱ组腰麻硬膜外联合阻滞(CSEA)组(n=120),先经第10~11胸椎或第11~12胸椎行硬膜外向上置管,再行第2~3腰椎或第3~4腰椎单次腰麻。Ⅲ组骶麻复合硬膜外组(n=120),先行单次骶麻,再经第10~11胸椎或第11~12胸椎行硬膜外向上置管。必要时辅用芬氟合剂,氯安合剂予以维持。结果与Ⅰ、Ⅲ组相比,Ⅱ组局麻药用量较少,起效时间明显缩短,术中镇痛效果和外科医生满意度方面优势明显,发生局麻药中毒可能性减小。但血流动力学波动较大,经处理后趋于平稳。Ⅲ组有4例骶麻操作失败。结论与两点硬膜外组和骶麻复合硬膜外组相比,CSEA综合腰麻和硬膜外两者之优点,具有起效快、镇痛效果更确切、肌松更充分、局麻药用量较少、不易发生局麻药中毒反应等优点,能较好地满足经输尿管镜钬激光碎石术的要求。
Objective To compare the effectiveness of two points of epidural, combined lumbar-epidural block and epidural sacral anesthesia for ureteroscopic holmium laser lithotripsy. Methods 360 patients with ASA Ⅰ ~ Ⅱ grade underwent ureteroscopic holmium laser lithotripsy were randomly divided into three groups. Group Ⅰ two epidural block (CEA) group (n = 120), two-point method: 10 to 11 thoracic or 11 to 12 thoracic epidural catheter, and then the first 3 to 4 lumbar or 4 ~ 5 lumbar epidural down the tube. Group Ⅱ spinal cord epidural block (CSEA) group (n = 120), first through the thoracic vertebrae 10 ~ 11 or 11 ~ 12 thoracic epidural catheter, and then 2 ~ 3 lumbar or 3 ~ 4 Lumbar single spinal anesthesia. Group Ⅲ sacral anesthesia combined epidural group (n = 120), the first single sacral anesthesia, and then by the thirteenth thoracic or 11 thru 12 thoracic epidural catheter. When necessary, supplemented with Fen fluoride mixture, chloride safety agent to be maintained. Results Compared with group Ⅰ and group Ⅲ, the dosage of local anesthetic in group Ⅱ was less, the time to onset of action was significantly shortened, the advantages of intraoperative analgesia and surgeon satisfaction were obvious, and the possibility of local anesthetic poisoning decreased. However, hemodynamic fluctuations, after treatment tends to be stable. Group Ⅲ had 4 cases of sacral anesthesia failed. Conclusion Compared with the two epidural and sacrococcygeal epidural groups, CSEA combines the advantages of both spinal anesthesia and epidural. It possesses rapid onset of action, more precise analgesic effect, more complete muscle relaxation, and local anesthetic Less dosage, less prone to local anesthetic poisoning reaction, etc., can better meet the ureteroscopic holmium laser lithotripsy requirements.