在局部或脊髓外皮麻醉下使用超声波引导的PCNL的安全性和有效性:一项元分析
Yong Cai1, Junbo Liu, Yong Chen
1Department of Urology, Chengdu Second People's Hospital, Chengdu, Sichuan Province, P.R. China.
在局部麻醉下进行皮肤瘤切除 (PCNL) 对上尿路结石是安全有效的. 这种方法比一般麻醉或脊髓外周麻醉提供更短的手术时间,更低的成本和更少的并发症.
科学领域:
- 泌尿外科
- 麻醉学
- 腎病的治療方法
背景情况:
- 穿皮瘤切除术 (PCNL) 是上尿路结石的一个关键手术.
- 麻醉选择影响PCNL的安全性和有效性.
- 局部透麻醉 (LIA) 是全身麻醉 (GA) 和结合脊髓外皮麻醉 (CSEA) 的替代方案.
研究的目的:
- 为了比较LIA和GA/CSEA下的超声波引导PCNL的安全性和有效性.
- 提供PCNL麻醉技术现有证据的元分析.
主要方法:
- 在多个数据库 (EMBASE,MEDLINE,Cochrane等) 中进行系统的文献搜索 直到2024年3月.
- 包括PCNL上尿路结石的随机和非随机研究.
- 使用固定或随机效应模型计算95%置信区间的概率比率和平均差异.
主要成果:
- 根据LIA,PCNL的运行时间显著缩短 (MD = -18.91,P < .00001).
- 与较低的住院费用 (MD = - 4097.43,P < .00001) 和并发症率 (OR = 0.49,P = .0005) 相关.
- 在LIA患者中观察到更短的术后住院时间 (MD=1.85,P=0.001),而没有明显的石头率差异.
结论:
- 在LIA,GA和CSEA下的PCNL都是安全有效的.
- 提供优势包括缩短操作时间,降低成本和减少并发症.
- 对于PCNL来说,LIA是一种可行的,可能有利的麻醉选择.
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