Application of percutaneous nephrolithotomy under ultrasound-guided paravertebral block anesthesia in high-risk patients
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摘要: 目的 探讨超声引导椎旁阻滞麻醉经皮肾镜取石术在高危患者中应用的安全性和有效性。方法 回顾性分析2017年5月—2022年6月东南大学附属中大医院收治的输尿管上段或肾脏结石46例，美国麻醉医师协会(ASA)分级Ⅲ~Ⅳ级，均行椎旁阻滞麻醉经皮肾镜取石术，观察患者术中及术后心率(HR)、收缩压(SBP)、舒张压(DBP)变化，视觉模拟评分(VAS)、清石率和并发症等。结果 46例患者术中生命体征平稳，不同时点HR、平均动脉压(MAP)差异无统计学意义(P>0.05)。术中术后VAS评分平稳，总的清石率接近100%，无感染性休克发生，无出血需要介入患者，无胸膜损伤和肠道损伤患者。结论 椎旁阻滞麻醉能为高危患者经皮肾镜取石术提供良好的镇痛效果。Abstract: Objective To investigate the safety and efficacy of percutaneous nephrolithotomy under ultrasound-guided paravertebral block anesthesia in high-risk patients.Methods From May 2017 to June 2022, 46 patients with upper ureteral or renal calculi admitted to the department of urology in Zhongda Hospital, Southeast University were retrospectively analysed. Percutaneous nephrolithotomy under paravertebral block anesthesia were performed for all patients who belonged to the American Society of Anesthesiologist (ASA) classification Ⅲ-Ⅳ. The changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), visual analogue scale (VAS), stone clearance rate and surgical complications were observed during and after operation.Results The vital signs of the 46 patients were stable during the operation. There was no significant difference in HR or mean arterial pressure (MAP) at different time points (P > 0.05). Intraoperative and postoperative VAS scores were stable, and the total stone clearance rate was close to 100%. There were no complications such as bleeding, infection, or peripheral organ damage in all cases.Conclusion Paravertebral block anesthesia can provide good analgesia for percutaneous nephrolithotomy in high-risk patients.
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表 1 46例患者不同时间点HR和MAP的变化
X±S 指标 T0 T1 T2 T3 T4 T5 P值 HR/(次·min-1) 74.3±6.2 76.7±6.1 74.9±6.2 73.8±6.0 73.7±6.1 74.8±6.4 0.188 MAP/mmHg 85.8±8.5 84.6±8.7 83.1±8.5 84.0±5.6 82.2±8.5 83.5±7.4 0.332 
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