闭孔神经阻滞复合全身麻醉在经尿道膀胱肿瘤电切术老年患者中的应用  

Application of ultrasound-guided obturator nerve block combined with general anesthesia in transarethral resection of bladder fumors for elderly patients

作　　者：吴城[1] 胡立 江能[2] 周红梅[1] Wu Cheng;Hu Li;Jiang Neng;Zhou Hongmei(Department of Anesthesiology,the Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China;Department of 18 Ward,the Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]嘉兴学院附属第二医院麻醉科,嘉兴314000 [2]嘉兴学院附属第二医院18病区,嘉兴314000

出　　处：《中华老年医学杂志》2020年第5期569-572,共4页Chinese Journal of Geriatrics

基　　金：嘉兴市科技局(2019AD32149)。

摘　　要：目的探讨在老年经尿道膀胱肿瘤电切术(TURBT)的老年人中应用超声引导下闭孔神经阻滞复合全身麻醉(全麻)的临床价值。方法在2017年11月至2019年8月本院所收治的老年膀胱肿瘤患者中随机抽取84例,按照是否进行闭孔神经阻滞将其分为观察组(全麻联合超声引导下闭孔神经阻滞,43例)和对照组(全麻,41例),对两组患者的手术、术后并发症发生及不良反应发生情况进行观察分析。结果观察组患者的手术时间、尿管留置时间、住院时间均明显短于对照组,术中出血量少于后者(均P<0.05);观察组患者闭孔神经损伤2例(4.65%),对照组患者闭孔神经损伤8例(19.51%),闭孔神经损伤发生率低于对照组(χ^2=4.420,P=0.036)。对照组发生膀胱出血2例和膀胱穿孔1例,观察组患者未发生膀胱出血和膀胱穿孔。对照组患者术后共计出现心动过速2例,恶心呕吐2例,低血压1例,发生率为12.16%;观察组患者术后共计出现心动过速3例,恶心呕吐1例,低血压2例,总发生率为13.95%。两组患者术后不良反应总发生率并无明显差异(χ^2=0.057,P=0.811)结论在TURBT手术中应用超声引导下闭孔神经阻滞复合全麻可有效增强对闭孔神经反射的抑制效果,有利于降低术中闭孔神经损伤风险,对于保障手术的顺利进行,促进患者术后顺利康复具有十分积极的作用。Objective To explore the clinical value of ultrasound-guided obturator nerve block combined with general anesthesia in transurethral resection of bladder tumors(TURBT)for the elderly.Methods A total of 84 elderly bladder tumor patients were randomly selected from those admitted to our hospital from November 2017 to August 2019,and were divided into the observation group(n=43)and the control group(n=41)according to whether obturator nerve block was performed.Patients in the observation group were given general anesthesia combined with ultrasound-guided obturator nerve block,and those in the control group were given general anesthesia alone.The surgical conditions,postoperative complications,and rates of adverse reactions were compared between the two groups.Results Patients in the observation group had a significantly shorter duration of operation,shorter indwelling urinary catheter use,fewer days stayed in hospital and less intraoperative blood loss,compared with the control group(all P<0.05).Besides,the incidence of obturator nerve injury in the observation group was also significantly lower than in the control group(4.65%vs.19.51%,χ^2=4.420,P=0.036).There were 2 cases of bladder hemorrhage and 1 case of bladder perforation in the control group,but no case of bladder hemorrhage or bladder perforation occurred in the observation group.A total of 2 cases of tachycardia,2 cases of nausea and vomiting,and 1 case of hypotension were seen in the control group;and 3 cases of tachycardia,1 case of nausea and vomiting,and 2 cases of hypotension occurred in the observation group.The total incidence of adverse reactions was similar between the two groups(12.16%vs.13.95%,χ^2=0.057,P=0.811).Conclusions The use of ultrasound-guided obturator nerve block combined with general anesthesia in TURBT surgery can effectively enhance the inhibitive effect on obturator nerve reflex,and reduce the risk of obturator nerve injury during surgery.Therefore,it can ensure smooth operation of the surgery and has a very positive effect on pr

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤电切术 闭孔神经阻滞 

分 类 号：R737.14[医药卫生—肿瘤] R614[医药卫生—临床医学]