前庭大腺切除术会阴区超声引导选择性神经阻滞与蛛网膜下隙麻醉的对照研究  

A Comparative Study of Ultrasound-Guided Selective Nerve Block in Perineal Area and Subarachnoid Anesthesia of the Vestibular Gland Resection

作　　者：周迎 胡铭仪 肖静 步莉娜 岳小芳 ZHOU Ying;HU Mingyi;XIAO Jing;BU Lina;YUE Xiaofang(Department of Anesthesiology,East Hospital of Shanghai Sixth People′s Hospital,Shanghai 201306,China;Department of Gynaecology and Obstetrics,East Hospital of Shanghai Sixth People′s Hospital,Shanghai 201306,China;Department of Neurology,East Hospital of Shanghai Sixth People′s Hospital,Shanghai 201306,China)

机构地区：[1]上海市第六人民医院东院麻醉科,上海201306 [2]上海市第六人民医院东院妇产科,上海201306 [3]上海市第六人民医院东院神经内科,上海201306

出　　处：《医学综述》2020年第11期2240-2245,共6页Medical Recapitulate

基　　金：国家自然科学基金(31400953)。

摘　　要：目的比较前庭大腺切除术会阴区超声引导选择性神经阻滞与蛛网膜下隙麻醉的血流动力学指标变化、镇痛效果及对并发症的影响。方法选取2018年1—12月在上海市第六人民医院东院因前庭大腺囊肿需行腺体切除术的女性患者60例,按麻醉方法不同分为对照组和观察组,各30例。其中,对照组行蛛网膜下隙麻醉,观察组行超声引导坐骨棘部矢状面阴部神经、髂外动脉旁生殖股神经生殖支、髂腹股沟神经阻滞。记录并比较两组患者麻醉前后的血流动力学指标[平均动脉压(MAP)、心率]变化、术中心血管活性药物使用次数、围手术期镇痛效果[麻醉后针刺痛开始消失时间、术后首次疼痛出现时间和运动开始恢复时间、术后镇痛药使用次数和术后各时段静息时的视觉模拟评分(VAS)]及术后并发症发生情况。结果麻醉后,观察组各时点间的MAP和心率均高于对照组(P<0.05),两组MAP和心率的组间、时点间、组间和时点间交互作用比较差异有统计学意义(P<0.05)。观察组的心血管活性药物人均使用次数少于对照组[(0.38±0.14)次比(1.31±0.24)次](P<0.01)。观察组的麻醉后针刺痛开始消失时间、术后首次疼痛出现时间均长于对照组[(28.4±7.6)min比(3.7±1.9)min,(530±155)min比(236±36)min](P<0.01),术后镇痛药的使用次数少于对照组[(2.7±0.8)次比(3.7±0.5)次](P<0.01)。对照组术后患者下肢运动恢复时间为(119.4±21.5)min,而观察组患者均未出现下肢运动丧失。观察组各时段静息时的VAS均低于对照组(P<0.01),组间、时点间、组间和时点间交互作用比较差异有统计学意义(P<0.01)。观察组的恶心呕吐发生率低于对照组[10.34%(3/29)比33.33%(10/30)](P<0.05),两组患者血管损伤和穿刺神经异感的发生率比较差异无统计学意义(P>0.05)。结论超声引导会阴区选择性神经阻滞对前庭大腺切除术患者的生命体征影响较小、镇痛时间持�Objective To compare the hemodynamic indexes,complications and the analgesic effects of ultrasound-guided selective perineal nerve block and subarachnoid anaesthesia on excision of Bartholin gland cyst.Methods A total of 60 female patients who undergoing greater vestibular adenectomy in Shanghai Sixth People′s Hospital East from Jan.to Dec.2018 according to different anesthesia methods were divided into two groups with 30 patients each.Among them,control group was given subarachnoid space anesthesia,and observation group was given ultrasonic-guided pudendal nerve-genitofemoral nerve reproductive branch joint-ilioinguinal nerve block.The records of the heart rate and mean arterial pressure(MAP)before and after anaesthesia,the times of using vasoactive drugs in the operation center,the effect of perioperative analgesia[the time of starting to disappear after anesthesia,the time of first postoperative pain and the time of starting to recover after exercise,the times of using analgesics after operation and the visual analog scale(VAS)of resting in each period after operation were recorded and compared between the two groups]and postoperative complications.Results After anesthesia,the MAP and heart rate of the observation group were higher than those of the control group at each time point(P<0.05).There were significant differences in the interaction between MAP and heart rate between groups and time points(P<0.05).The number of cardiovascular active drugs used per person in the observation group was less than that in the control group[(0.38±0.14)times vs(1.31±0.24)times](P<0.01).The time of acupuncture pain disappearance and the onset time of postoperative pain in the observation group were longer than those in the control group[(28.4±7.6)min vs(3.7±1.9)min,(530±155)min vs(236±36)min](P<0.01).The number of postoperative analgesics was less than that of the control group[(2.69±0.85)times vs(3.70±0.47)times](P<0.01).The recovery time of lower limb movement in the control group was(119.37±21.51)min,while in t

关 键 词：会阴区超声引导选择性神经阻滞 蛛网膜下隙麻醉 前庭大腺切除术 

分 类 号：R614.4[医药卫生—麻醉学]