不同麻醉方法预防经尿道膀胱肿瘤切除术中闭孔神经反射的临床观察

Abstract

目的比较在经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)中3种麻醉方法对患者闭孔神经反射和术后并发症的影响。方法回顾性分析我院2014年1月～2016年12月90例膀胱镜检查诊断为浅表性膀胱肿瘤接受TURBT的临床资料,依据麻醉方法分为3组:全身麻醉组(G组),脊椎-硬膜外麻醉组(C组),脊椎-硬膜外麻醉复合闭孔神经阻滞组(O组),每组30例。比较3组患者手术时间、出血量、闭孔神经反射发生率、膀胱损伤发生率、术后心血管和肺部并发症发生率、住院时间。结果 3组患者膀胱损伤、手术时间、出血量、术后心血管并发症、术后肺部并发症差异均无统计学意义(P> 0. 05)。闭孔神经反射发生率C组为40. 0%,显著高于G组3. 3%(χ~2=11. 882,P=0. 001)和O组0. 0%(P=0. 000)。G组患者住院时间中位数7. 0(6. 0,8. 0) d,明显长于C组6. 0(5. 0,6. 0) d (Z=-2. 798,P=0. 015)和O组5. 0(5. 0,7. 3) d(Z=-2. 913,P=0. 011)。结论全身麻醉和脊椎-硬膜外麻醉复合闭孔神经阻滞均可有效预防TURBT术中患者的闭孔神经反射。

Objective To compare effects of three different anesthetic methods on obturator nerve reflex and postoperative complications in patients undergoing transurethral resection of bladder tumor( TURBT). Methods A retrospective analysis was conducted according to the medical records of 90 patients with lateral wall or multiple superficial bladder tumor treated with TURBT in our hospital from January 2014 to December 2016. The patients were given general anesthesia( Group G),or spinal-epidural anesthesia( Group C),or spinal-epidural anesthesia with obturator nerve block( Group O),with 30 cases in each group. The operation time,blood loss,incidence of obturator nerve reflex,incidence of bladder injury,incidence of postoperative cardiovascular and pulmonary complications,and length of hospital stay were observed and analyzed respectively. Results There were no significant differences in the incidence of bladder injury,operation time,blood loss,incidence of postoperative cardiovascular and pulmonary complications( P > 0. 05). The incidence of obturator nerve reflex in the group C was 40. 0%,which was significantly higher than that in the group G( 3. 3%,χ~2= 11. 882,P = 0. 001) and group O( 0. 0%,P = 0. 000). The median length of hospital stay in the group G was 7. 0( 6. 0,8. 0) d,which was significantly longer than that of the group C [6. 0( 5. 0,6. 0) d,Z =-2. 798,P = 0. 015] and group O [5. 0( 5. 0,7. 3) d,Z =-2. 913,P = 0. 011]. Conclusion General aesthesia and spinal-epidural anesthesia combined with obturator nerve block can effectively prevent obturator nerve reflex during TURBT.