超声引导下前列腺周围神经阻滞麻醉在前列腺穿刺活检中的应用

An analgesia study of periprostatic nerve block for transrectal ultrasound guided biopsy of the prostate

目的 探讨超声引导下前列腺周围神经阻滞麻醉应用于前列腺穿刺活检中的麻醉效果. 方法 回顾性分析2010年7月至2013年12月我院223例前列腺穿刺活检患者.分为两组,神经阻滞组116例,会阴区皮肤局部麻醉后再行直肠超声引导下前列腺包膜局部麻醉加前列腺神经阻滞麻醉;局麻组107例,单纯会阴区皮肤加前列腺包膜局部麻醉.两组麻醉成功后行经会阴前列腺穿刺活检术.记录穿刺后即刻视觉模拟疼痛评分（visual analogue scale,VAS）,同时记录并发症情况.结果 两组间年龄、穿刺前血清PSA水平、前列腺体积及穿刺针数比较差异均无统计学意义（P＞0.05）.神经阻滞组VAS评分0～7,平均2.3±1.1;局麻组VAS评分0～10,平均4.9±2.3.两组之间比较差异有统计学意义（P＜0.05）.神经阻滞组术后发生肉眼血尿37.1％ （43/116）、血精3.4％（4/116）、尿潴留1.7％ （2/116）,局麻组分别为39.3％（42/107）、4.7％（5/107）和1.9％ （2/107）,组间比较差异均无统计学意义（P＞0.05）. 结论 超声引导下前列腺周围神经阻滞麻醉在行经会阴前列腺穿刺活检患者中具有止痛效果好、安全的优点.

Objective To evaluate the anestheisa efficacy of periprostatic nerve block in transrectal ultrasound （TRUS） guided biopsy of the prostate.Methods A total of 223 patients received prostate biopsy in our hospital from July 2010 to December 2013 were retrospectively studied,and were divided randomly into two groups.One hundred and sixteen cases in nerve block group accepted local anesthesia of prostate capsule and periprostatic nerve block after local perineal skin anesthetia,and 107 cases in local anesthesia group only accepted local perineal skin anesthetia and local anesthesia of prostate capsule.Patients in the 2 groups underwent prostate biopsy successfully.The visual analogue scale （VAS） and complications were recorded.Results The age,serum PSA level before biopsy,prostate volume and the number of puncture needles had no significant differences between the 2 groups （P＞0.05）.The average VAS score was 2.3± 1.1,and 4.9±2.3 in the 2 groups.The VAS had significant difference between the 2 groups （P＜0.05）.The incidences of hematuria,hemospermia and urinary retention were 37.1％ （43/116）,3.4％ （4/116） and 1.7％ （2/116） in nerve block group,and 39.3％ （42/107）,4.7％ （5/107） and 1.9％ （2/107） in local anesthesia group.The difference was not significant （P＞0.05）.Conclusion Periprostatic nerve block for TRUS guided biopsy of the prostate could be safe with good analgesic effect.