两种麻醉方法在膀胱侧壁肿瘤电切术中的比较

Comparison of two different anesthesia methods in transurethral resection of bladder tumor

目的比较在腰硬联合麻醉(CSEA)或全身麻醉(GA)下TURBt手术治疗浅表性膀胱侧壁肿瘤的有效性和安全性。方法 2012年1月至2014年6月,东莞市人民医院术前诊断为浅表性膀胱侧壁肿瘤患者60例,密闭信封法分为CSEA、GA两组。记录两组患者年龄、性别、ASA分级、病史和肿瘤大小、数目等临床资料,观察比较两组患者术中闭孔反射发生率、膀胱穿孔率、手术时间、出血量、住院费用,以及血压、心率、血氧饱和度变化情况。结果 60例浅表性膀胱侧壁肿瘤患者纳入本研究,CSEA组和GA组分别30例,两组患者一般临床资料无统计学差异,术中两组患者生命体征均维持在正常范围内,CSEA组8例(26.7%)术中发生闭孔反射,其中1例出现膀胱穿孔,GA组无闭孔反射和膀胱穿孔病例,但GA组住院费用较CSEA组费用高(P<0.05)。结论 GA或CSEA均可用于TURBt治疗浅表性膀胱侧壁肿瘤,CSEA组患者住院费用低廉,但GA组患者术中安全性更好。

Objective To compare the efficacy and safety of combined spinal-epidural anesthesia （CSEA） and general anesthesia（GA） for transurethral resection of the bladder tumor. Methods Between January 2012 and June 2014, patients with superficial bladder tumor were randomly selected for CSEA or GA using envelopes and enrolled in this study. The clinical characteristics of Patients such as patients＆#39; blood pressure, heart rate, oxyhemoglobin saturation, operative time and side-effects in these two groups were evaluated. Results 60 cases were included in this study; 30 patients in CSEA group and 30 patients in GA group. No significant differences were found between the two groups in basic Characteristics. GA group experienced more stable hemodynamics than those in CSEA group. Obturator nerve reflex was observed in 8 （26.7%） patients in CSEA group, but none in GA group. However, the hospitalization expenses of GA group are signifcantly higher than CSEA group（P〈0.05）. Conclusion Both CSEA and EA are applicable to TURBt for superficial bladder tumor, but GA is more safety than CSEA for this procedure.