超声引导下双侧闭孔神经阻滞复合全身麻醉在膀胱肿瘤电切术中的应用  

Application of ultrasound-guided bilateral obturator nerve block combined with general anesthesia in patients undergoing transurethral resection of bladder tumor

作　　者：余湘元 王韦玮[1] 施凌燕[1] 孙皆[1] YU Xiang-yuan;WANG Wei-wei;SHI Ling-yan;SUN Jie(Department of Anesthesiology,the Second People's Hospital of Kunshan,Kunshan 215300,Jiangsu,China)

机构地区：[1]昆山市第二人民医院麻醉科,江苏昆山215300

出　　处：《川北医学院学报》2021年第10期1355-1358,共4页Journal of North Sichuan Medical College

基　　金：江苏省昆山市科技计划项目(KS18082)。

摘　　要：目的:探讨超声引导下双侧闭孔神经阻滞复合全身麻醉对经尿道膀胱肿瘤切除术(TURBT)患者术中闭孔神经反射的预防效果及对应激反应的影响。方法:按照麻醉方式不同将90例拟行TURBT术的膀胱肿瘤患者分为对照组(n=45)和观察组(n=45)。对照组予以全身麻醉,观察组予以超声引导下闭孔神经阻滞复合全身麻醉;比较两组手术一般情况、闭孔神经反射等并发症情况、术后不良反应,于术前及术后24 h行血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-6)、IL-8]水平的测定。结果:相比对照组,观察组的手术时间较短,术中出血量较少,麻醉满意度评分较高,术后下床时间提前,术后住院时间较短,差异均有统计学意义(P<0.05)。观察组闭孔神经反射发生率为6.67%,低于对照组的22.22%(P<0.05);两组膀胱穿孔、膀胱出血发生率及术后不良反应发生率对比,差异均无统计学意义(P>0.05)。术后24 h,两组血清TNF-α、IL-6、IL-8水平均增高(P<0.05),且观察组低于对照组(P<0.05)。结论:超声引导下双侧闭孔神经阻滞复合全身麻醉能够有效预防TURBT术中闭孔神经反射,减轻手术应激反应,促进术后恢复。Objective:To investigate the effect of ultrasound-guided obturator nerve block combined with general anesthesia on the prevention of obturator nerve reflex and stress response in patients undergoing transurethral resection of bladder tumor(TURBT).Methods:90 patients with bladder cancer were divided into control group(n=45)and observation group(n=45)according to the different anesthesia methods.The control group was given general anesthesia,and the observation group was given ultrasound-guided obturator nerve block combined with general anesthesia.The general situation of operation,obturator nerve reflex and other complications,postoperative adverse reactions were compared between the two groups.The serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-8]were measured before and 24 hours after operation.Results:Compared with the control group,the observation group had shorter operation time,less intraoperative blood loss,higher anesthesia satisfaction score,earlier postoperative ambulation time and shorter postoperative hospital stay(P<0.05).The incidence of obturator nerve reflex in the observation group was 6.67%,which was significantly lower than 22.22%in the control group(P<0.05).There was no significant difference in the incidence of bladder perforation,bladder bleeding and postoperative adverse reactions between the two groups(P>0.05).24 hours after operation,the serum levels of TNF-α,IL-6 and IL-8 in the two groups were increased,but the levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Ultrasound-guided obturator nerve block combined with general anesthesia can effectively prevent obturator nerve injury in TURBT surgery,reduce surgical stress response and promote postoperative recovery.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤切除术 闭孔神经反射 神经阻滞 预防 

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