[1]段江锋① 王健阁 乾孝园 孙嘉豪 张雪军**.超声引导下椎旁神经阻滞与全身麻醉在经皮肾镜取石术中的应用比较[J].中国微创外科杂志,2025,01(1):8-13.
　Duan Jiangfeng,Wang Jiange*,Qian Xiaoyuan*,et al.Comparison of Ultrasoundguided Paravertebral Block and General Anesthesia in Percutaneous Nephrolithotomy[J].Chinese Journal of Minimally Invasive Surgery,2025,01(1):8-13.
点击复制

超声引导下椎旁神经阻滞与全身麻醉在经皮肾镜取石术中的应用比较()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年1期
页码:
8-13
栏目:
临床论著
出版日期:
2025-01-25

文章信息/Info

Title:
Comparison of Ultrasoundguided Paravertebral Block and General Anesthesia in Percutaneous Nephrolithotomy
作者:
段江锋① 王健阁 乾孝园 孙嘉豪 张雪军**
(湖北文理学院附属襄阳市中心医院泌尿外科，襄阳441021)
Author(s):
Duan Jiangfeng;  Wang Jiange*;  Qian Xiaoyuan*;  et al.
*Department of Urology, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, China
关键词:
椎旁神经阻滞; 全身麻醉; 经皮肾镜取石术
Keywords:
Paravertebral block; General anesthesia; Percutaneous nephrolithotomy
文献标志码:
A
摘要:
目的比较超声引导下椎旁神经阻滞(paravertebral block，PVB)与全身麻醉在经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)中的麻醉效果。方法2023年 1月~2024年3月我院行284例经皮肾镜碎石术，其中椎旁阻滞麻醉78例(PVB组)、全身麻醉206例(全麻组)，经倾向性评分匹配，2组各61例，比较2组手术时间、输液量、术后血红蛋白变化、术后疼痛视觉模拟评分（Visual Analogue Scale,VAS)、住院时间、住院费用、术后并发症等。结果2组均顺利完成手术，手术过程中生命体征稳定，术中均未出现明显心动过缓、呼吸抑制、低血压等麻醉并发症。2组手术开始前心率（heart rate,HR) ［(66.5±10.4)次/min vs.(77.5±11.7)次/min，t=-5.471，P=0.000］、手术结束时HR ［(60.5±8.4)次/min vs.(71.0±12.3)次/min，t=-5.472，P=0.000］，手术开始前平均动脉压（mean arterial pressure,MAP)［(97.2±11.9)mm Hg vs.(103.1±12.3)mm Hg，t=-2.694，P=0.008］、手术结束时MAP ［(85.2±8.8)mm Hg vs.(94.3±11.6)mm Hg，t=-4.892，P=0000］，手术开始前SpO2 ［(99.0±1.1)% vs.(99.6±0.6)%，t=-3.347，P=0.001］、手术结束时SpO2 ［(99.2±1.1)% vs.(99.8±0.4)%，t=-4.122，P=0.000］差异有显著性，但均在正常范围内。PVB组手术时间显著短于全麻组［55.0(41.5，75.5)min vs.95.0(650，130.0)min，Z=-5.173，P=0000］。PVB组术后血红蛋白变化［5(2，11)g/L vs.8(4，11)g/L，Z=-2.099，P=0.036］、术后疼痛VAS评分［1(1，1)分vs.1(1，2)分，Z=-3.342，P=0.001］、术后住院时间［3(2，3)d vs.4(3，6)d，Z=-6.016，P=0.000］、住院费用［(14 499.4±2141.0)元vs.(19 634.2±3846.8)元，t=-9.109，P=0.000］显著低于/短于全麻组。2组术中输液量［600(600，600)ml vs. 600(600，1100)ml，Z=-1.800，P=0.072］、术后排气时间［1(1，1)d vs.1(1，1)d，Z=-1.045，P=0.296］、一期结石清除率［88.5%(54/61)vs.82.0%(50/61)， χ2=1.043，P=0.307］差异无显著性。PVB组术后并发症发生率显著低于全麻组［66%(4/61)vs.19.7%(12/61)， χ2=4.604，P=0.032］。结论超声引导下PVB能维持PCNL术中患者生命体征稳定，缩短手术时间，减少出血量，减轻术后疼痛，减少术后并发症，缩短术后住院时间，节省医疗费用，具有良好的安全性和有效性。
Abstract:
ObjectiveTo compare the effectiveness between ultrasoundguided paravertebral block (PVB) and general anesthesia in percutaneous nephrolithotomy (PCNL).MethodsClinical data of 284 patients who underwent PCNL in our hospital from January 2023 to March 2024 were collected. These were 78 cases of PVB (PVB group) and 206 cases of general anesthesia (general anesthesia group). A total of 61 cases in each of the two groups were matched with propensity score, and the operative time, intraoperative fluid infusion volume, postoperative haemoglobin changes, postoperative visual analogue scale (VAS), hospital stay, hospital costs, and incidence of postoperative complications were compared.ResultsThe operations were completed in both groups of patients successfully, with stable vital signs during the operation and no intraoperative anesthetic complications such as bradycardia, respiratory depression, or hypotension. There were significant differences between the two groups in heart rate (HR) before the start of surgery ［(66.5±10.4) beats/min vs.(77.5±11.7) beats/min, t=-5.471,P=0.000］, HR at the end of surgery ［(60.5±84) beats/min vs.(71.0±12.3) beats/min, t=-5.472, P=0.000］, mean arterial pressure (MAP) before the start of surgery ［(97.2±11.9) mm Hg vs.(103.1±12.3) mm Hg, t=-2.694, P=0.008］, MAP at the end of surgery ［(852±8.8) mm Hg vs.(94.3±11.6) mm Hg, t=-4.892, P=0.000］, pulse oxygen saturation (SpO2) before the start of surgery ［(99.0±1.1)% vs.(99.6±0.6)%, t=-3.347, P=0.001］ and SpO2 at the end of surgery ［(99.2±1.1)% vs.(99.8±0.4)%, t=-4.122, P=0.000］. The operative time was significantly shorter in the PVB group than that in the general anesthesia group ［55.0 (41.5,755) min vs.95.0 (65.0,130.0) min, Z=-5.173, P=0.000］. The postoperative haemoglobin changes ［5 (2,11) g/L vs.8(4,11) g/L, Z=-2.099, P=0.036］, postoperative VAS score ［1 (1,1) points vs. 1 (1,2) points, Z=-3.342, P=0001］, postoperative hospital stay ［3 (2,3) d vs. 4 (3,6) d, Z=-6.016, P=0.000］ and hospital costs ［(14 499.4±2141.0） yuan vs.（19 634.2±3846.8） yuan, t=-9.109, P=0.000］ were statistically lower in the PVB group than those in the general anesthesia group. Comparison of intraoperative fluid infusion volume ［600 (600,600) ml vs.600 (600,1100) ml, Z=-1.800, P=0.072］, postoperative venting time ［1 (1,1) d vs. 1(1,1) d, Z=-1.045, P=0.296］, and phase Ⅰ stone removal rate ［88.5%(54/61) vs.82.0%(50/61), χ2=1.043, P=0307］ showed no significant differences between the two groups. The incidence of postoperative complications in the PVB group was significantly lower than that in the general anesthesia group ［6.6%(4/61) vs.19.7%(12/61), χ2=4.604, P=0.032］.ConclusionUltrasoundguided PVB in PCNL maintains stable intraoperative vital signs, reduces operative time and bleeding, alleviates postoperative pain, reduces postoperative complications and postoperative hospital stay, and saves medical costs, having a good safety and efficacy.

参考文献/References:

[1]付汉川,晋学飞,李宏岩.2种微创方法治疗CT值≤1200 HU的2～4 cm肾结石的疗效对比.中国微创外科杂志,2023,23(8):576-580.
[2]Pu C, Wang J, Tang Y, et al. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and metaanalysis. Urolithiasis,2015,43(5):455-466.
[3]Fei M, Qin W, An G, et al. Comparison of paravertebral block vs. general anesthesia for percutaneous nephrolithotomy: A retrospective study. Front Med (Lausanne),2023,10:1081530.
[4]胡嘏,杨欢,彭鄂军,等.超声引导椎旁神经阻滞麻醉用于经皮肾镜取石术的疗效观察.中华泌尿外科杂志,2017,38(3):201-205.
[5]中华医学会泌尿外科学分会结石学组,中国泌尿系结石联盟.经皮肾镜取石术中国专家共识.中华泌尿外科杂志,2020,41(6):401-404.
[6]吕联辉,杜虹志,张文彬,等.输尿管软镜与微通道经皮肾镜碎石术治疗老年患者2.0~3.0 cm非下盏肾结石的疗效比较.中国微创外科杂志,2024,24(4):261-266.
[7]张华,毛厚平,江涛,等.经皮肾镜取石术患者围手术期应用加速康复外科理念的探讨.福建医科大学学报,2019,53(3):187-190.
[8]Harkouk H, Fletcher D, Martinez V. Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery. Reg Anesth Pain Med,2021,46(3):251-257.
[9]Chen N, Qiao Q, Chen R, et al. The effect of ultrasoundguided intercostal nerve block, singleinjection erector spinae plane block and multipleinjection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, doubleblinded, clinical trial. J Clin Anesth,2020,59:106-111.
[10]Blum KA, Parkhomenko E, Thai J, et al. A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy. World J Urol,2018,36(9):1461-1467.
[11]周先科,陈君,唐媛,等.超声引导下椎旁神经阻滞复合右美托咪定麻醉在经皮肾镜碎石取石术中的应用.微创泌尿外科杂志,2018,7(3):177-180.
[12]刘磊,刘经纬,彭思维.超声引导下胸椎旁神经阻滞与腰硬联合麻醉在经皮肾镜碎石术中的临床疗效比较.临床外科杂志,2017,25(10):785-787.
[13]Guymer C, Jahan S, Bahrami B, et al. Calciphylaxis, beware the ophthalmic mimic: A case series. Clin Nephrol Case Stud,2023,11:136-146.
[14]黄芳.超声引导下椎旁神经阻滞在经皮肾手术中的应用.现代诊断与治疗,2017,28(1):137-138.
[15]Maldonato NM, Sperandeo R, Caiazzo G, et al. Keep moving without hurting: The interaction between physical activity and pain in determining cognitive function at the population level. PLoS One,2018,13(6):e0197745.
[16]Zhao Y, Kan Y, Huang X, et al. The efficacy and safety of paravertebral block for postoperative analgesia in renal surgery: A systematic review and metaanalysis of randomized controlled trials. Front Surg,2022,18;9:865362.
[17]张剑,王兴耀,王定伦,等.超声引导下椎旁神经阻滞复合右美托咪定持续泵注与单纯全麻用于老年患者经皮肾镜手术的效果比较.中外医疗,2021,40(8):28-31,35.
[18]Ding X, Jin S, Niu X, et al. A comparison of the analgesia efficacy and side effects of paravertebral compared with epidural blockade for thoracotomy: an updated metaanalysis. PLoS One,2014,9(5):e96233.

备注/Memo

备注/Memo:
基金项目：湖北省自然科学基金项目（2023AFB866）**通讯作者，Email：3096017279@qq.com ①（武汉科技大学医学部医学院，武汉430065）
更新日期/Last Update: 2025-03-28