超声引导下阴部神经阻滞在后尿道成形术中的应用  

Application of ultrasound-guided pudendal nerve block in posterior urethroplasty

作　　者：丁倩 陈潇潇 刘溪[1] 张俊峰[1] 顾晨桃[1] DING Qian;CHEN Xiaoxiao;LIU Xi;ZHANG Junfeng;GU Chentao(Department of Anesthesiology,Shanghai Sixth People s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《同济大学学报（医学版）》2022年第4期534-538,544,共6页Journal of Tongji University(Medical Science)

摘　　要：目的探讨超声引导下侧卧位经臀部入路阴部神经阻滞在成人后尿道成形术中的应用价值。方法选取拟行后尿道成形术的患者120例,采用随机数字表法分为阴部神经阻滞组(PNB组)与对照组,每组各60例。PNB组术前行超声引导下侧卧位双侧PNB。两组均行喉罩全身麻醉,术后均予静脉自控镇痛(patient-controlled intravenous anesthesia,PCIA)。记录术中舒芬太尼第一次追加时间及总用量,术后不同时间点的视觉模拟评分(visual analogue scale,VAS),术后补救镇痛次数,患者满意度及不良反应的发生率。结果PNB组首次阻滞成功率96.67%,平均操作时间为(7±2.1)min。与对照组相比,PNB组首次追加舒芬太尼的时间明显延长,舒芬太尼的总用量明显减少(P<0.01);术后1、6、12、24 h镇痛效果较好(P<0.05);术后24 h内追加镇痛药物次数明显减少,首次疼痛时间(VAS评分≥4分)延长(P<0.05);患者满意度明显提高(P<0.05);不良反应发生率差异无统计学意义(P>0.05)。结论超声引导下侧卧位经臀部入路PNB操作便捷、成功率高,可降低后尿道成形术患者术中阿片类药物的使用量,并提供有效的术后镇痛效果,加速患者下床活动,且不增加不良反应发生率。Objective To evaluate the application of ultrasound-guided pudendal nerve block in posterior urethroplasty.Methods One hundred and twenty patients undergoing posterior urethroplasty in Shanghai Sixth People s Hospital during January to December 2019 were included in this study.Patients were randomly divided into ultrasound-guided pudendal nerve group(PNB group,n=60)and control group(n=60).Before surgery,th ultrasound-guided bilateral pudendal nerve block was performed through gluteal approach in lateral decubitus position for patients in PNB group.Patients in both groups received laryngeal mask general anesthesia and patient-controlled intravenous anesthesia(PCIA)after surgery.The first additional time and total dosage of sufentanil,the postoperative pain VAS scores at different time points,the number of successfully delivered doses,the requirements for rescue analgesia,the patient satisfaction and the adverse effects rate were recorded.Results PNB was effective in 96.67%of cases on the first attempt.The mean procedure duration was(7±2.1)min.Compared with control group,the first additional time of sufentanil was prolonged significantly,and the total dosage significantly decreased(P<0.01).The VAS scores of PNB group were significantly decreased at 1,6,12 and 24 h after surgery(P<0.05).The total requirements for rescue analgesia during PCIA were significantly decreased in PNB group(P<0.05).The first postoperative pain time point(VAS scores≥4)was prolonged significantly in PNB group(P<0.05).The patient satisfaction in PNB group was significantly higher than that in control group(P<0.05).There was no significant difference(P>0.05)in the incidence of adverse effects between two groups.Conclusion Ultrasound-guided pudendal nerve block through gluteal approach in lateral decubitus position is convenient to perform with a good success rate in posterior urethroplasty.It can reduce the dosage of sufentanil,and effectively improve the analgesic effect after surgery without increasing the incidence of adverse effects.

关 键 词：超声引导 阴部神经阻滞 后尿道成形术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学]