超声引导下ONB复合喉罩全身麻醉在老年患者TURBt中的应用  

Application of ultrasound-guided obturator nerve block combined with laryngeal mask general anesthesia in elderly patients undergoing TURBt

作　　者：胡立 吴城[1] 闫巍巍 周红梅[1] HU Li;WU Cheng;YAN Weiwei;ZHOU Hongmei(Department of Anesthesiology,Second Affiliated Hospital of Jiaxing University,Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴学院附属第二医院麻醉科,浙江嘉兴314000

出　　处：《重庆医学》2021年第23期4071-4075,共5页Chongqing medicine

基　　金：浙江省嘉兴市科技计划项目(2019AD32149)。

摘　　要：目的探讨超声引导下闭孔神经阻滞(ONB)复合喉罩全身麻醉应用于老年患者经尿道膀胱镜下膀胱肿瘤电切术(TURBt)的有效性、安全性及炎性因子、脑损伤因子表达水平。方法选取该院择期行TURBt的老年膀胱侧壁肿瘤患者80例,采用随机数字表法将患者分为观察组和对照组,每组40例。观察组在超声引导下行ONB后不使用肌松药物的喉罩插管全身麻醉,对照组给予常规喉罩插管全身麻醉。观察并比较两组患者术中闭孔神经反射(ONR)发生率、术后拔管清醒时间、麻醉复苏期躁动发生率、术后肺部并发症(PPCs)发生率、术后平均住院时间,术前30 min(T1)、肿瘤电切时(T2)、肿瘤电切后5 min(T3)、手术结束时(T4)的平均动脉压(MAP)、心率(HR)、手术体积描记指数(SPI);T1、麻醉后60 min(T5)、术后24 h(T6)检测两组患者白细胞介素(IL)-6、IL-8、IL-1β、肿瘤坏死因子-α(TNF-α)、S100β蛋白及神经元特异性烯醇化酶(NSE)水平;评估并记录T1、T6、术后3 d(T7)时成人简易精神状态评价量表(MMSE)评分。结果两组患者术中ONR发生率比较,差异无统计学意义(P>0.05);观察组患者术后拔管清醒时间、术后麻醉复苏期躁动发生率、PPCs发生率、术后平均住院时间均明显低于对照组(P<0.05);T1、T4时两组患者血流动力学指标和SPI比较,差异无统计学意义(P>0.05);T2、T3时观察组患者血流动力学指标和SPI波动明显低于对照组(P<0.05);T1时两组MMSE评分比较,差异无统计学意义(P>0.05),T6、T7时观察组患者MMSE评分明显高于对照组(P<0.05)。T1时两组患者IL-6、IL-8、IL-1β、TNF-α、S100β蛋白、NSE水平比较,差异无统计学意义(P>0.05);T5、T6时观察组患者IL-6、IL-8、IL-1β、TNF-α、S100β蛋白水平明显低于对照组(P<0.05),NSE水平明显高于对照组(P<0.01)。结论喉罩全身麻醉联合ONB在老年患者TURBt中安全有效,且可减少术后认知功能障碍的发生率,减轻术中�Objective To explore the effectiveness,safety and expression levels of inflammatory factors and brain injury factors of ultrasound-guided obturator nerve block(ONB)combined with laryngeal mask general anesthesia in elderly patients with transurethral resection bladder tumor(TURBt).Methods Eighty elderly cases undergoing elective TURBt in this hospital were selected and divided into the observation group and control group by adopting the random number table method,40 cases in each group.The observation group conducted the laryngeal mask intubation general anesthesia without using muscle relaxants after ultrasound-guided ONB,and the control group was given the conventional laryngeal mask intubation general anesthesia.The incidence rate of intraoperative obturator nerve reflex(ONR),clear time of postoperative extubation,agitation incidence rate during anesthesia recovery,incidence rate of postoperative pulmonary complications(PPCs)and average postoperative hospital stay duration were observed and compared between the two groups;the mean arterial pressure(MAP),heart rate(HR)and surgical plethysmography index(SPI)of the two groupswere measured at 30 min before operation(T1),tumor resection(T2),5 min after tumor resection(T3)and at the end of operation(T4).The mini mental state examination(MMSE)scores were evaluated and recorded at T1,24 h(T6)and on 3 d(T7).The levels of IL-6,IL-8,IL-1β,TNF-α,S100βprotein and neuron specific enolase(NSE)were detected at T1,60 min after anesthesia(T5)and T6.Results There was no statistically significant difference in the incidence rate of intraoperative ONR between the two groups(P>0.05);the clear time of postoperative extubation,incidence rate of postoperative agitation during anesthesia recovery,incidence rate of PPCs and the average postoperative hospital stay time in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the hemodynamic indexes and SPI at T1 and

关 键 词：超声引导 闭孔神经阻滞 经尿道膀胱镜下膀胱肿瘤电切术 老年患者 术后认知功能障碍 炎症因子 

分 类 号：R614[医药卫生—麻醉学]