腰麻-硬膜外联合麻醉对膀胱逼尿肌收缩功能的影响  

Effect of combined spinal-epidural anesthesia on the function of bladder detrusor contraction

作　　者：高义胜[1] 王莹 高佃军[1] 刘亮[1] 何廉波[1] 宁厚山[1] 王军[1] 祝增军[1] 张玉海 

机构地区：[1]潍坊医学院研究生院,山东潍坊261000 [2]北京燕化医院,北京102500

出　　处：《中国性科学》2012年第5期3-5,8,共4页Chinese Journal of Human Sexuality

基　　金：首都医学科研发展基金(2009-3176)

摘　　要：目的:研究腰麻-硬膜外联合麻醉(combined spinal-epidural anesthesia,CSEA)前后患者膀胱尿动力学的变化,为麻醉后拔出导尿管的时机选择提供客观理论依据。方法:2010年11月～2011年11月,选取69例腰麻-硬膜外联合麻醉手术病人,男38例,女31例;年龄18～70岁,平均35岁,分别在麻醉前1～2h(对照组)、麻醉诱导成功后、麻醉结束后、以后每2h(麻醉后第2h、4h、6h、……)进行一次尿动力学检查(充盈性膀胱压力容积测定、压力-流率测定),直至患者能成功自行排尿,统计学分析麻醉前后尿动力学参数的变化。结果:36例男性患者在麻醉结束后6h成功自行排尿,结束尿动力学检查,排尿期最大逼尿肌压力与对照组无统计学差异(P>0.05),2例男性患者1例拔出尿道测压管后自行排尿成功,1例按摩膀胱区后排尿成功。28例女性患者在麻醉结束后10h成功排尿,结束尿动力学检查,排尿期最大逼尿肌压力与对照组无统计学差异(P>0.05),其余3例女性患者在麻醉后10h拔出尿道测压管后也成功自行排尿。结论:腰麻-硬膜外联合麻醉结束后,男性患者约在6h、女性患者约在10h膀胱逼尿肌收缩功能恢复至麻醉前状态,可拔出尿管。Objectives： To study the effect of combined spinal- epidural anesthesia （CSEA） on the detrusor contractility and to provide theoretical foundations for the choice of proper time to remove catheter. Methods： From Nov. 2010 to Nov. 201 l, we selected 59 cases with CSEA, 38 males and 31 females, aged 18 to 70, with the mean age of 35. The uredynamic analysis of the patients were made accordingly 1 ~ 2h before surgery （the control group）, fight after the anesthesia, and every subsequent 2h （2h, 4h, 6h, 8h ） after anesthesia until the detrusor contractile function recovered and patients voided successfully. Then the changes of urodymamic parameters were statistically analyzed. Results： Six of the 36 male patients successfully urinated 6h after the anesthesia and terminated the urodynamic tests. Pdet - max in the study group had no significant difference as compared with the control group （ P 〉 0.05 ）. For the remaining 2 male patients, one could urinate by himself after the removal of the cathe- ter, and one successfully voided after bladder area massage. For the female patients, 28 could urinate by themselves 10h after an- esthesia and terminated their urodynamlc tests. Like the male patients, the Pdet - max had no significant difference as compared with the control group （ P 〉 0.05 ）. The remaining 3 female patients could urinate by themselves after the removal of the catheter.Conclusions ： After CSEA, the male patients need about 6 hours and the female patients 10 hours for the recovery of their detru- sor contractile function, which indicates the proper time for their catheter removal.

关 键 词：腰麻-硬膜外联合麻醉 逼尿肌 尿动力学 

分 类 号：R614.4[医药卫生—麻醉学]