Plutchok J J, Kortis H I, Amory D W, Wagner B K
Department of Anesthesia, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey.
J Stone Dis. 1992 Jul;4(3):235-42.
Extracorporeal shock wave lithotripsy (ESWL) is the most widely used treatment for renal calculi. Newer second generation lithotripters are being produced, which are considered to be less painful than their prototypes. Thus, the trend in anesthesia for ESWL is away from general endotracheal and regional anesthesia and toward less involved and more easily monitored techniques such as intravenous analgesia (IVA). This report relates our experience with a continuous alfentanil infusion for ESWL treatment of renal calculi with a nonimmersion second generation Dornier HM-4 lithotripter model. Thirty-five patients treated pre-operatively with droperidol and midazolam, followed by a continuous infusion of alfentanil, reported excellent pain relief via a numerical pain score and manifested little, if any, hypertension or tachycardia. Stone fragmentation, fluoroscopy, and recovery time did not differ between patients receiving IVA or general anesthesia. Potential disadvantages of IVA include elevation of transcutaneous CO 2, bradycardia in 14 patients requiring the use of atropine, slightly longer ESWL time, increased number of shocks needed for fragmentation, and a small failure rate, with 11% of patients requiring general anesthesia. With proper patient selection and respiratory monitoring, IVA is highly recommended for ESWL in the treatment of renal calculi.
体外冲击波碎石术（ESWL）是治疗肾结石应用最广泛的方法。新一代第二代碎石机正在生产，其被认为比原型机疼痛程度更低。因此，ESWL麻醉的趋势正从全身气管内麻醉和区域麻醉转向参与度更低、更易于监测的技术，如静脉镇痛（IVA）。本报告讲述了我们使用持续输注阿芬太尼，通过非浸入式第二代多尼尔HM - 4碎石机对肾结石进行ESWL治疗的经验。35例患者术前接受氟哌利多和咪达唑仑治疗，随后持续输注阿芬太尼，通过数字疼痛评分报告疼痛缓解良好，且几乎未出现高血压或心动过速。接受IVA或全身麻醉的患者在结石破碎、透视检查及恢复时间方面并无差异。IVA的潜在缺点包括经皮二氧化碳升高、14例患者出现心动过缓需使用阿托品、ESWL时间稍长、破碎所需冲击次数增加以及小的失败率，11%的患者需要全身麻醉。经过适当的患者选择和呼吸监测，IVA在肾结石ESWL治疗中强烈推荐使用。
