预防经尿道膀胱肿瘤电切术中闭孔神经反射的麻醉方法比较

Comparative study on anesthesia methods of preventing obturator nerve reflection during transurethral resection of the bladder tumor

目的探讨比较在经尿道膀胱肿瘤电切术（TURBt）中三种不同的麻醉方式对于预防闭孔神经反射的效果，从而选择最佳的麻醉方式。方法回顾性分析中山大学附属第三医院2014年1月至2015年4月间收治的ASAI～Ⅱ级经膀胱镜检查诊断为侧壁或多发表浅性膀胱肿瘤，行TUR．Bt的患者。根据麻醉方式的不同，将其分为三组：椎管内麻醉组（A组）、全麻组（B组）和椎管内麻醉联合闭孔神经阻滞麻醉组（C组），每组30例。比较3组患者术前、术中和手术结束时平均动脉压（MAP）、心率（HR）的变化以及手术时间，统计闭孔神经反射次数，是否引起严重的并发症（膀胱穿孔，大出血等）。结果三组患者一般情况和术前、术中、术后的生命体征比较差异均无统计学意义（P〉0．05）。在预防闭孔神经反射发生概率方面，A组与B、C组相比，差异具有统计学意义（P〈0．05）。B组与C组相比差异无统计学意义（P〉0．05）。结论椎管内麻醉复合闭孔神经阻滞与全身麻醉均可以较好地抑制经尿道膀胱肿瘤电切术中闭孔神经反射发生。

Objective To compare the effects of three different ways of anesthesia in preventing obturator nerve reflection during transurethral resection of the bladder tumor （TURBT）. Methods 90 patients （ASA I-II） who were diagnosed as lateral wall or multiple superficial bladder tumor underwent TURBT from January 2014 to April 2015 in the Third Affiliated Hospital of Sun Yat-sen University. Patients were randomly accepted intraspinal anesthesia （group A）, general anesthesia （group B） or spinal anesthesia combined with obturator nerve block anesthesia （group C）, 30 cases in each group. The perioperative period change of MAP, HR, time of surgery, cases of obturator nerve reflection and severe complications such as bladder perforation and massive haemorrhage were observed and analyzed retrospectively. Results There were no significant differences in general situation and vital signs between the groups （P〉 0.05）. The rate of obturator nerve reflection in group A was higher than group B and group C （P〈0.05）, Group B and C were similar （P〉 0.05）. Conclusions Intraspinal anesthesia combining obturator nerve block and general anesthesia can provide satisfactory anesthetic effect and reduce the rate of obturator nerve reflection during transurethral resection of bladder tumor.