腰硬联合麻醉在经尿道膀胱肿瘤电切术中的应用  

The Application of Combined Spinal and Epidural Block Anesthesia in Transurethral Resection of Bladder Tumor

作　　者：吴慰芳[1] 李新伟[2] 张海平[1] 韩南火[1] 

机构地区：[1]南昌大学第四附属医院麻醉科,南昌330003 [2]南昌大学第四附属医院泌尿外科,南昌330003

出　　处：《实用临床医学（江西）》2010年第3期51-53,共3页Practical Clinical Medicine

摘　　要：目的比较腰麻-硬脊膜外阻滞麻醉与硬脊膜外阻滞麻醉用于经尿道膀胱肿瘤电切术中的效果。方法将40例膀胱肿瘤患者随机分为2组:腰麻-硬脊膜外阻滞麻醉组(A组)和硬脊膜外阻滞麻醉组(B组),每组20例。穿刺部位均选择L2-3椎间隙,A组采用腰麻-硬脊膜外阻滞麻醉,B组采用硬脊膜外阻滞麻醉。观察2组术中麻醉平面达T10阻滞时间、麻醉效果、局部麻醉药用量(盐酸罗哌卡因和利多卡因)、平均动脉压(MAP)、心率(HR)变化及头痛、穿孔和闭孔神经反射等不良反应情况。结果A组麻醉平面达到T10阻滞时间及盐酸罗哌卡因、利多卡因用量均少于B组(P<0.01),A组麻醉效果与B组比较,差异有统计学意义(P<0.01)。A组麻醉后5minMAP、HR与B组比较,差异有统计学意义(P<0.01)。A组头痛、穿孔及闭孔神经反射发生率均明显低于B组(P<0.01)。结论腰麻-硬脊膜外阻滞麻醉用于经尿道膀胱肿瘤电切术中有效、安全,麻醉效果优于硬脊膜外阻滞麻醉。Objective To compare the effect of spinal anesthesia-epidural block anesthesia alone in transurethral resection of bladder tumor.Methods Forty patients with bladder tumor were randomly divided into two groups：spinal-epidural block anesthesia group （group A） and the epidural block anesthesia group （group B）,with 20 cases in each group.The puncture site had opted for the L 2-3 intervertebral space.Group A received spinal anesthesia-epidural block anesthesia,while group B did epidural block anesthesia.The block time of anaesthesia level reach T 10,anesthetic effect,amount of local anesthetic （ropivacaine hydrochloride and lidocaine）,mean arterial pressure （MAP）,heart rate （HR） changes and headache,perforated and obturator nerve reflex and other adverse reactions were observed.Results The block time of anaesthesia level reach T 10,amount of local anesthetic （ropivacaine and lidocaine hydrochloride） in group A were less than that in group B（P〈0.01）.The difference of anesthesia effect was statistically significant between group A and group B（P〈0.01）.The difference was statistically significant in MAP,HR at 5 minutes after anesthesia between group A and group B （P〈0.01）.The headache,bladder perforation,and incidence of obturator-nerve-reflex of group A were significantly lower than those of group B （P〈0.01）.Conclusion The spinal anesthesia-epidural block anesthesia for transurethral resection of bladder tumors maybe more effective,safe and more effective than epidural anesthesia block anesthesia.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤电切术 腰麻-硬脊膜外阻滞麻醉 硬脊膜外阻滞麻醉 盐酸罗哌卡因 利多卡因 

分 类 号：R614.27[医药卫生—麻醉学]