腰-硬联合麻醉复合超声引导下闭孔神经阻滞在TURBT术中的应用  

Application of spinal-epidural anesthesia combined with ultrasound-guided obturator nerve block in transurethral resection of bladder tumors

作　　者：李海斌 张训功 孙帅 LI Hai-bin;ZHANG Xun-gong;SUN Shuai(Department of Anesthesiology,the Fifth Clinical Medical College of Henan University of Traditional Chinese Medicine(Zhengzhou People's Hospital),Zhengzhou 450000,Henan,CHINA)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)麻醉科,河南郑州450000

出　　处：《海南医学》2024年第17期2459-2463,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划-联合共建项目(编号:LHGJ20220799)。

摘　　要：目的探讨腰-硬联合麻醉复合超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术(TURBT)中的应用效果。方法前瞻性选取2020年1月至2023年1月于郑州人民医院行TURBT术的86例膀胱肿瘤患者作为研究对象,根据随机数表法将患者分为观察组(腰-硬联合麻醉复合超声引导下闭孔神经阻滞)和对照组(腰-硬联合麻醉)各43例。比较两组患者的手术一般情况(麻醉时间、手术时间、术中出血量、术后住院时间、导管留置时间)、麻醉满意度和麻醉方式满意度、各时间点(麻醉前、麻醉后5 min、麻醉后30 min及手术结束时)平均动脉压(MAP)和心率(HR)、手术前后血气分析指标[动脉血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]和疼痛程度[视觉模拟量表(VAS)]及术后不良反应发生情况。结果观察组患者术后麻醉时间、手术时间、术中出血量、术后住院时间和尿管留置时间明显短(少)于对照组,差异均有统计学意义(P<0.05);观察组患者麻醉满意度及麻醉方式满意度评分明显高于对照组,差异均有统计学意义(P<0.05);麻醉前两组患者的MAP及HR水平比较差异均无统计学意义(P>0.05);观察组患者麻醉后各时间点的MAP及HR与其麻醉前比较差异均无统计学意义(P>0.05),而对照组患者麻醉后各时间点的MAP及HR与其麻醉前比较差异均有统计学意义(P<0.05),且麻醉后各时间点,观察组患者的HR明显低于对照组,而MAP明显高于对照组,差异均有统计学意义(P<0.05);术前及术后,两组患者的SaO_(2)、PaO_(2)、PaCO_(2)水平比较差异均无统计学意义(P>0.05),但术后24 h,观察组患者的VAS评分为(2.09±0.88)分,明显低于对照组的(4.51±1.27)分,差异有统计学意义(P<0.05);观察组患者的总不良反应率为6.98%,明显低于对照组的37.21%,差异有统计学意义(P<0.05)。结论腰-硬联合麻醉复合超声引导下闭孔神经阻滞在TURBT术中应用Objective To compare the effects of spinal-epidural anesthesia combined with ultrasound-guided obturator nerve block in transurethral resection of bladder tumors(TURBT).Methods A total of 86 patients with blad-der tumor who underwent TURBT in Zhengzhou People's Hospital from January 2020 to January 2023 were prospective-ly selected as the research subjects.According to the random number table method,the patients were divided into the ob-servation group(43 cases,spinal-epidural anesthesia combined with ultrasound-guided obturator nerve block)and the control group(43 cases,spinal-epidural anesthesia).The general conditions of operation(anesthesia duration,operation duration,intraoperative blood loss,postoperative hospital stay,indwelling time of catheter),satisfaction with anesthesia and anesthesia method,mean arterial pressure(MAP)and heart rate(HR)at each time points(before anesthesia,5 min after anesthesia,30 min after anesthesia,and at the end of operation)were compared between the two groups,as well as blood gas analysis indexes before and after operation(arterial oxygen saturation,SaO_(2);arterial partial pressure of carbon dioxide,PaCO_(2);arterial partial pressure of oxygen,PaO_(2)),pain score(Visual Analogue Scale,VAS)changes,and postop-erative adverse reactions.Results The postoperative anesthesia duration,operation duration,intraoperative blood loss,postoperative hospital stay,and indwelling time of catheter in the observation group were significantly lower than those in the control group(P<0.05).The scores for satisfaction with anesthesia and satisfaction with anesthesia method in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in MAP and HR between the two groups before anesthesia(P>0.05).There was no significant difference in MAP and HR levels between the observation group at each time point after anesthesia and before anesthesia(P>0.05).The levels of MAP and HR in the control group at each time point after anesthesia were sig

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤电切术 超声 麻醉 闭孔神经阻滞 

分 类 号：R699.5[医药卫生—泌尿科学]