“鸡尾酒”方案联合硬膜外麻醉预防膀胱侧壁肿瘤电切术中闭孔神经反射的效果  

Effect of"cocktail"regimen combined with epidural anesthesia in preventing obturator nerve reflex during electrocision of bladder lateral wall tumor

作　　者：吴荣华 刘型 贾维胜 陈宇 汪娟 包晓航 付卫华 陈伟 WU Rong-hua;LIU Xing;JIA Wei-sheng;CHEN Yu;WANG Juan;BAO Xiao-hang;FU Wei-hua;CHEN Wei(Department of Urology,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Orthopedics,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China;Department of Anesthesiology,Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院泌尿外科,重庆400037 [2]陆军军医大学第二附属医院骨科,重庆400037 [3]陆军军医大学第二附属医院麻醉科,重庆400037

出　　处：《局解手术学杂志》2021年第7期569-573,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然基金面上项目(81970590)。

摘　　要：目的探讨“鸡尾酒”方案注射联合硬膜外麻醉在膀胱侧壁肿瘤电切术中对于闭孔神经反射的预防效果。方法将93例膀胱侧壁肿瘤患者采用信封法分为观察组(48例)和对照组(45例)。观察组采用硬膜外麻醉,将膀胱注射针沿侧壁膀胱肿瘤边界0.5 cm处逐步注射罗哌卡因+肾上腺素+地塞米松混合的“鸡尾酒”混合液,在膀胱肿瘤基底部及周围形成一圈“水垫”,然后行膀胱肿瘤电切。对照组硬膜外麻醉后采用常规的膀胱肿瘤电切,对于有闭孔神经反射发生的病例,采用观察组的“水垫”注射方案后再行电切。观察2组闭孔神经反射发生率、手术时间、切除深度(是否含有肌层)、膀胱穿孔、出血量、基底部切缘情况。结果2组闭孔神经反射发生率比较,差异具有统计学意义(P=0.036)。2组手术时间比较,差异无统计学意义(P=0.802);2组出血量比较,差异有统计学意义(P=0.042);观察组基底部切缘阳性1例(2.0%),对照组基底部切缘阳性6例(13.3%),差异有统计学意义(P=0.031)。观察组无膀胱穿孔发生,对照组有1例患者发生膀胱穿孔(P=0.704);所有病例标本均含有肌层。结论采用罗哌卡因+肾上腺素+地塞米松联合的“鸡尾酒”膀胱肿瘤基底部注射,可以有效减少闭孔神经反射发生;且不会增加患者的创伤,该方法简单、可靠、有效,值得推广。Objective To explore the preventive effect of"cocktail"injection combined with epidural anesthesia on obturator nerve reflex during electrocision of bladder lateral wall tumor.Methods A total of 93 patients with bladder lateral wall tumor were divided into the observation group(48 cases)and the control group(45 cases)by envelope method.In the observation group,epidural anesthesia was performed,and the bladder injection needle was gradually injected with a mixture of ropivacaine+epinephrine+dexamethasone at 0.5 cm along the boundary of the bladder lateral wall tumor,after a circle of"water cushion"at and around the base of bladder tumor was formed,the electrocision of bladder tumor was performed.The control group was treated with conventional electrocision of bladder tumor after epidural anesthesia,for patients with obturator nerve reflex,the observation group’s"water cushion"injection method was performed before electrocision.The incidence of obturator nerve reflex,operation time,depth of resection(whether it contained muscle layer or not),bladder perforation,blood loss and basal margin of the two groups were observed.Results There was a statistically significant difference in the incidence of obturator nerve reflex between the two groups(P=0.036).There was no statistically significant difference in operation time between the two groups(P=0.802).There was a statistically significant difference in the blood loss between the two groups(P=0.042).There was 1 case(2.0%)with positive basal margin in the observation group and 6 cases(13.3%)with positive basal margin in the control group,and the difference between the two groups was statistically significant(P=0.031).There was no bladder perforation in the observation group,and 1 case had bladder perforation in the control group(P=0.704).All case specimens contained muscular layer.Conclusion The"cocktail"injection of ropivacaine+adrenaline+dexamethasone at the base of the bladder tumor can effectively reduce the occurrence of obturator nerve reflex and will not increas

关 键 词：“鸡尾酒” 硬膜外麻醉 膀胱侧壁肿瘤 电切术 闭孔神经反射 

分 类 号：R694[医药卫生—泌尿科学]