喉罩静脉麻醉联合阴部神经阻滞麻醉在混合痔手术中的应用效果研究  

Laryngeal mask anesthesia combined with pudendal nerve block in patients under⁃going surgery for mixed hemorrhoids

作　　者：干丹 季峰 崔灿[1] 金磊[1] 秦凯健 王诗伊 蒋嘉奇 李盈[1] Gan Dan;Ji Feng;Cui Can;Jin Lei;Qin Kaijian;Wang Shiyi;Jiang Jiaqi;Li Ying(Department of Anorectal Diseases,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai Univer-sity of T.C.M,Shanghai 200437,China;Department of Anesthesiology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of T.C.M,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院肛肠科,上海200437 [2]上海中医药大学附属岳阳中西医结合医院麻醉科,上海200437

出　　处：《结直肠肛门外科》2020年第6期687-690,共4页Journal of Colorectal & Anal Surgery

基　　金：上海市卫生健康委员会(青年)项目(20174Y023);中医特色诊疗技术提升项目(zyjx-2017008);上海市卫生健康委员会中医药科研项目(2020JQ006);上海中医药大学附属岳阳中西医结合医院青年孵育项目(2019YYQ26)。

摘　　要：目的评价喉罩静脉麻醉联合阴部神经阻滞(PNB)在混合痔手术中的安全性及镇痛效果。方法选择上海中医药大学附属岳阳中西医结合医院肛肠科2020年1月至2020年9月60例符合纳入标准的Ⅲ度混合痔手术患者为研究对象,采用随机数字表法分为观察组(喉罩静脉麻醉联合PNB)和对照组(喉罩静脉麻醉联合局部浸润麻醉),每组各30例。观察两组患者麻醉前、麻醉后10 min、麻醉清醒后心率、血压的波动情况,术后不同时间点的疼痛情况及术后麻醉并发症发生率,比较两种麻醉方式的安全性及镇痛效果。结果两组患者麻醉前、麻醉后10 min、麻醉清醒后的心率、血压比较差异均无统计学意义(均P>0.05),观察组术后6 h、12 h的VAS评分低于对照组,差异均有统计学意义(均P<0.05),两组术后24 h、48 h VAS评分及术后尿潴留等并发症总发生率比较差异均无统计学意义(均P>0.05)。结论在混合痔手术中,采用喉罩静脉麻醉联合PNB安全有效,可减轻患者术后早期疼痛,且并不增加并发症发生率,具有一定的临床应用价值。Objectives To investigate the safety and analgesic effect of laryngeal mask anesthesia combined with pudendal nerve block in patients undergoing surgery for mixed hemorrhoids.Methods Sixty patients with gradeⅢmixed hemorrhoids who fulfilled the study criteria and underwent surgery at the Department of Anorectal Diseases,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of T.C.M,were recruited from January to September in 2020.They were randomly assigned to treatment group and control group with 30 patients in each group.The treatment group received laryngeal mask anesthesia combined with pudendal nerve block,and the control group received laryngeal mask anesthesia com⁃bined with local infiltration anesthesia.Heart rate and blood pressure were recorded before anesthesia,10 min after anesthesia,and at recovery from anesthesia.Pain visual analog scale(VAS)was evaluated at different time points after surgery.Anesthesiaassociated complications were recorded.Safety and analgesic effect was compared between the two groups.Results The two groups did not differ in heart rate and blood pressure before anesthesia,10 min after anesthesia,and at recovery from anesthesia(P>0.05).Pain VAS at 6 and 12 hours after surgery was significantly lower in the treatment group than in the control group(P<0.05).Pain VAS at 24 and 48 hours after surgery and the total incidence of complications such as urinary retention did not dif⁃fer significantly between the two groups(P>0.05).Conclusion For mixed hemorrhoids surgery,laryngeal mask anesthesia com⁃bined with pudendal nerve block is a safe procedure.It can alleviate early postoperative pain and does not increase the risk of complications.It has the potential for broader clinical use.

关 键 词：混合痔 阴部神经阻滞 局部浸润麻醉 喉罩静脉麻醉 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]