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目的观察近端输尿管结石钬激光碎石术中针药复合麻醉的效果。方法将63例近端输尿管结石患者随机分为治疗组(34例)和对照组(29例),治疗组采用针药复合麻醉,行输尿管镜钬激光碎石术;对照组采用腰麻,行输尿管镜钬激光碎石术;分别于麻醉前、术中、术后观察患者的各项生命体征、相关临床生化指标,术后评价临床镇痛疗效。结果治疗组麻醉前、术中、术后收缩压、心率和血氧饱和度比较,差异无统计学意义(P>0.05);对照组术中、术后心率与麻醉前比较,差异有统计学意义(P<0.05);组间术中、术后同期比较,心率差异有统计学意义(P<0.05)。治疗组术中与麻醉前比较,胰岛素、皮质醇差异有统计学意义(P<0.05);术后与麻醉前比较,血糖、胰岛素差异有统计学意义(P<0.05);术后与术中比较,胰岛素、皮质醇差异有统计学意义(P<0.05)。对照组术中与麻醉前比较,胰岛素、皮质醇差异有统计学意义(P<0.05);术后与麻醉前比较,血糖、胰岛素差异有统计学意义(P<0.05);术后与术中比较,血糖、胰岛素、皮质醇差异有统计学意义(P<0.05)。组间术中比较,胰岛素、皮质醇差异有统计学意义(P<0.05);术后比较,血糖差异有统计学意义(P<0.05)。治疗组、对照组镇痛总有效率分别为91.2%、89.7%;组间镇痛效果比较,差异无统计学意义(P>0.05)。治疗组术中、术后一般情况良好,对照组术后有8例患者出现穿刺点疼痛、腰酸、恶心、呕吐、头痛等。结论针药复合麻醉用于钬激光碎石术治疗近端输尿管结石的麻醉效果良好,对生理活动干扰少,无明显的临床不良反应。
Objective To observe the effect of acupuncture combined with anesthesia in proximal ureteral calculus holmium laser lithotripsy. Methods Sixty-three patients with proximal ureteral calculi were randomly divided into treatment group (n = 34) and control group (n = 29). The treatment group was treated with acupuncture combined with holmium laser lithotripsy. The control group was treated with spinal anesthesia Ureteroscopic holmium laser lithotripsy; before and after anesthesia, the patients were observed various vital signs, clinical and biochemical indicators, postoperative evaluation of analgesic efficacy. Results There was no significant difference in systolic blood pressure, heart rate and oxygen saturation before, during and after anesthesia in the treatment group (P> 0.05). The intraoperative and postoperative heart rate in the control group were statistically different from those before anesthesia (P <0.05). There was significant difference in heart rate between the two groups during surgery and at the same period (P <0.05). There were significant differences in insulin and cortisol between the two groups before and after anesthesia (P <0.05). There was a significant difference in blood glucose and insulin between before and after anesthesia in the treatment group (P <0.05) Comparison, insulin, cortisol differences were statistically significant (P <0.05). There were significant differences in insulin and cortisol between the two groups before and after anesthesia (P <0.05). There was a significant difference in blood glucose and insulin between before and after anesthesia (P <0.05) The differences of blood glucose, insulin and cortisol were statistically significant (P <0.05). There were significant differences in insulin and cortisol between the two groups (P <0.05). There was significant difference in blood glucose between the two groups after operation (P <0.05). The total effective rate of the treatment group and the control group was 91.2% and 89.7% respectively. There was no significant difference in analgesic effect between the two groups (P> 0.05). In the treatment group, the postoperative general conditions were good. In the control group, there were 8 cases of puncture point pain, backache, nausea, vomiting and headache after operation. Conclusion Acupuncture combined with anesthesia for holmium laser lithotripsy for the treatment of proximal ureteral calculi with good anesthesia, little disturbance to physiological activity, no obvious clinical adverse reactions.