芬太尼联合丁卡因胶浆小剂量硬膜外麻醉在经皮肾镜碎石术中的应用价值
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摘要
目的探讨芬太尼联合丁卡因胶浆小剂量硬膜外麻醉在经皮肾镜碎石术中的应用价值。方法选取我院2016年10月～2017年10月收治的152例需经皮肾镜碎石术治疗患者作为研究对象,按照双盲数字表方法分为单纯组(76例)与联合组(76例)。单纯组采用单纯硬膜外麻醉方法,联合组采用芬太尼联合丁卡因胶浆小剂量硬膜外麻醉方法。比较两组的心动过缓发生情况、低血压发生情况、不同时间点(麻醉前、安置输尿管导管时、碎石5 min、碎石20 min)血流动力学各指标[平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及心率(HR)]的变化情况。结果两组的心动过缓发生率、低血压发生率比较,差异无统计学意义(P>0.05)。两组麻醉前、安置输尿管导管时、碎石5 min及碎石20 min时的SpO2比较,差异无统计学意义(P>0.05)。两组麻醉前的MAP、HR比较,差异无统计学意义(P>0.05)。联合组安置输尿管导管时、碎石5 min及碎石20 min时的MAP、HR均低于单纯组,差异有统计学意义(P<0.05)。结论在经皮肾镜碎石术中,采用芬太尼+丁卡因胶浆联合小剂量硬膜外进行麻醉,可减少对患者血流动力学稳定性的影响,安全性高,值得临床推广应用。
Objective To investigate the application value of low-dose epidural anesthesia with Fentanyl and Tetracaine Jelly in the percutaneous nephrolithotripsy. Methods A total of 152 patients who underwent percutaneous nephrolithotripsy in our hospital from October 2016 to October 2017 were enrolled. The patients were divided into the single group(n=76) and tha combined group(n=76) according to a double-blind digital table method. In the single group, epidural anesthesia alone was used, and in the combined group, a small dose of epidural anesthesia with Fentanyl and Tetracaine Jelly was adopted. The occurrence of bradycardia and hypotension, and haemodynamics indexes including mean arterial pressure(MAP), saturation of pulse oximetry(SpO2), and heart rate(HR) at different time points including before anesthesia, placement of ureteral catheter, 5-min lithotripsy, and 20-min lithotripsy were compared in the two groups. Results There was no significant difference in the incidence of bradycardia and hypotension between the two groups(P>0.05). There was no significant in SpO2 before anesthesia, at placement of ureteral catheter, 5-min lithotripsy, and 20-min lithotripsy in the two groups(P>0.05). There was no significant difference in MAP and HR between the two groups before anesthesia(P>0.05). While during the ureteral catheter placement, at 5-min lithotripsy,and 20-min lithotripsy in the combined group, both MAP and HR were lower than those in the single group, with statistical significance(P<0.05). Conclusion In percutaneous nephrolithotripsy, Fentanyl combined with Tetracaine Jelly at a low-dose epidural anesthesia can reduce the impact on hemodynamic stability of patients. It is safe and worthy of promotion and application in clinic.
Objective To investigate the application value of low-dose epidural anesthesia with Fentanyl and Tetracaine Jelly in the percutaneous nephrolithotripsy. Methods A total of 152 patients who underwent percutaneous nephrolithotripsy in our hospital from October 2016 to October 2017 were enrolled. The patients were divided into the single group(n=76) and tha combined group(n=76) according to a double-blind digital table method. In the single group, epidural anesthesia alone was used, and in the combined group, a small dose of epidural anesthesia with Fentanyl and Tetracaine Jelly was adopted. The occurrence of bradycardia and hypotension, and haemodynamics indexes including mean arterial pressure(MAP), saturation of pulse oximetry(SpO2), and heart rate(HR) at different time points including before anesthesia, placement of ureteral catheter, 5-min lithotripsy, and 20-min lithotripsy were compared in the two groups. Results There was no significant difference in the incidence of bradycardia and hypotension between the two groups(P>0.05). There was no significant in SpO2 before anesthesia, at placement of ureteral catheter, 5-min lithotripsy, and 20-min lithotripsy in the two groups(P>0.05). There was no significant difference in MAP and HR between the two groups before anesthesia(P>0.05). While during the ureteral catheter placement, at 5-min lithotripsy,and 20-min lithotripsy in the combined group, both MAP and HR were lower than those in the single group, with statistical significance(P<0.05). Conclusion In percutaneous nephrolithotripsy, Fentanyl combined with Tetracaine Jelly at a low-dose epidural anesthesia can reduce the impact on hemodynamic stability of patients. It is safe and worthy of promotion and application in clinic.
引文
[1]贺聿国,薛建军,申治国,等.芬太尼+丁卡因胶浆联合小剂量硬膜外麻醉在经皮肾镜碎石术中的应用效果[J].山西医药杂志,2017,46(23):2924-2926.
[2]陈金荣.丙泊酚、芬太尼复合小剂量咪唑安定静脉麻醉在妇产科门诊手术中的应用[J].中国处方药,2016,14(4):50-51.
[3]曹云.瑞芬太尼全麻在经皮肾镜碎石手术麻醉中的应用价值[J].昆明医科大学学报,2016,37(1):133-136.
[4]孙建军,肖敏.七氟烷-瑞芬太尼复合喉罩通气全麻在经尿道输尿管镜钬激光碎石术中的应用[J].现代医药卫生,2017,33(13):1974-1976.
[5]蔺益红,陈国庆.关于盐酸丁卡因胶浆对全身麻醉苏醒期男性导尿患者躁动的影响分析[J].新疆医学,2017,47(7):727-729.
[6]吕欢欢,吕国义,卢悦淳.闭环回路麻醉输注系统在经尿道输尿管镜下碎石术中的应用[J].山东医药,2016,56(46):91-94.
[7]李兰兰.瑞芬太尼与芬太尼静脉麻醉在老年患者手术麻醉中的效果比较[J].中国继续医学教育,2016,8(20):48-50.
[8]李宁,朱玉霖.不同剂量布比卡因腰硬联合麻醉对老年经皮肾镜碎石术血流动力学的影响[J].医学综述,2015,21(22):4210-4212.
[9]刘艳莉.不同剂量布比卡因脊髓麻醉联合硬膜外麻醉对行经皮肾镜碎石术的老年患者血流动力学的影响[J].临床医药文献电子杂志,2017,4(84):16 594,16 623.
[10]余红.俯卧位、侧卧位对经皮肾镜碎石术的影响[J].四川医学,2016,37(5):527-529.
[11]刘敏,黄丽娟,朱浩杰,等.高血压患者经皮肾镜碎石术硬膜外麻醉与全麻应用效果比较[J].医药前沿,2018,8(14):97.
[12]李召亮,吕新,孟巧,等.联合腰麻硬膜外麻醉或全凭静脉麻醉在经皮肾镜碎石术的运用[J].当代医学,2017,23(9):46-48.
[13]赵宏宇,赵天瑶,张宇晴,等.糖尿病患者经皮肾镜碎石术的麻醉方法与麻醉效果研究[J].糖尿病新世界,2018,21(2):31-32.
[14]梁明.硬膜外麻醉联合丙泊酚在俯卧位经皮肾镜钬激光碎石术中的应用[J].华夏医学,2016,29(2):145-148.
[15]武利兵.输尿管镜碎石术联合管路封堵器与经皮肾镜治疗输尿管上段结石的疗效比较[J].临床医药文献电子杂志,2016,3(28):5535-5536.
[16]沈文锦.右美托咪定与丙泊酚用于硬膜外麻醉下经皮肾镜气压弹道碎石术镇静效果的对照研究[J].心血管外科杂志(电子版),2017,6(1):13-14.
[2]陈金荣.丙泊酚、芬太尼复合小剂量咪唑安定静脉麻醉在妇产科门诊手术中的应用[J].中国处方药,2016,14(4):50-51.
[3]曹云.瑞芬太尼全麻在经皮肾镜碎石手术麻醉中的应用价值[J].昆明医科大学学报,2016,37(1):133-136.
[4]孙建军,肖敏.七氟烷-瑞芬太尼复合喉罩通气全麻在经尿道输尿管镜钬激光碎石术中的应用[J].现代医药卫生,2017,33(13):1974-1976.
[5]蔺益红,陈国庆.关于盐酸丁卡因胶浆对全身麻醉苏醒期男性导尿患者躁动的影响分析[J].新疆医学,2017,47(7):727-729.
[6]吕欢欢,吕国义,卢悦淳.闭环回路麻醉输注系统在经尿道输尿管镜下碎石术中的应用[J].山东医药,2016,56(46):91-94.
[7]李兰兰.瑞芬太尼与芬太尼静脉麻醉在老年患者手术麻醉中的效果比较[J].中国继续医学教育,2016,8(20):48-50.
[8]李宁,朱玉霖.不同剂量布比卡因腰硬联合麻醉对老年经皮肾镜碎石术血流动力学的影响[J].医学综述,2015,21(22):4210-4212.
[9]刘艳莉.不同剂量布比卡因脊髓麻醉联合硬膜外麻醉对行经皮肾镜碎石术的老年患者血流动力学的影响[J].临床医药文献电子杂志,2017,4(84):16 594,16 623.
[10]余红.俯卧位、侧卧位对经皮肾镜碎石术的影响[J].四川医学,2016,37(5):527-529.
[11]刘敏,黄丽娟,朱浩杰,等.高血压患者经皮肾镜碎石术硬膜外麻醉与全麻应用效果比较[J].医药前沿,2018,8(14):97.
[12]李召亮,吕新,孟巧,等.联合腰麻硬膜外麻醉或全凭静脉麻醉在经皮肾镜碎石术的运用[J].当代医学,2017,23(9):46-48.
[13]赵宏宇,赵天瑶,张宇晴,等.糖尿病患者经皮肾镜碎石术的麻醉方法与麻醉效果研究[J].糖尿病新世界,2018,21(2):31-32.
[14]梁明.硬膜外麻醉联合丙泊酚在俯卧位经皮肾镜钬激光碎石术中的应用[J].华夏医学,2016,29(2):145-148.
[15]武利兵.输尿管镜碎石术联合管路封堵器与经皮肾镜治疗输尿管上段结石的疗效比较[J].临床医药文献电子杂志,2016,3(28):5535-5536.
[16]沈文锦.右美托咪定与丙泊酚用于硬膜外麻醉下经皮肾镜气压弹道碎石术镇静效果的对照研究[J].心血管外科杂志(电子版),2017,6(1):13-14.
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