前列腺体积对经会阴前列腺穿刺活检中前列腺周围神经阻滞麻醉效果的影响

Effect of prostate volume on the peripheral nerve block anesthesia in prostate biopsy

目的探讨超声引导下前列腺周围神经阻滞麻醉在不同体积前列腺穿刺活检中的麻醉效果。方法回顾性总结2013年5月至2015年9月在苏北人民医院泌尿外科行超声引导下经会阴前列腺穿刺活检的568例患者资料。将患者按接受麻醉方式不同分为神经阻滞组和局部麻醉组，两组再根据患者前列腺体积大小分为20-40 ml、〉40-60 ml、〉60-100 ml、〉100 ml 4个亚组。各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法（VAS）评分和视觉数字评分法（VNS）评分，同时记录术后并发症发生情况。局部麻醉组和神经阻滞组各亚组间及亚组内VAS、VNS评分的比较采用非参数分析Mann-Whitney U检验和单因素方差分析；局部麻醉组和神经阻滞组各亚组间及亚组内并发症发生率的比较采用χ^2检验。结果局部麻醉组各亚组VAS评分分别为1.9±0.9、2.8±1.5、3.8±2.3、5.3±2.5，神经阻滞组各亚组VAS评分分别为1.5±0.7、2.0±0.8、2.9±1.7、4.2±2.0；局部麻醉组各亚组VNS评分分别为3.4±0.6、2.9±0.6、2.7±0.5、1.6±0.7，神经阻滞组各亚组VNS评分分别为3.7±0.5、3.3±0.4、3.0±0.8、2.0±0.7。局部麻醉组和神经阻滞各亚组间和亚组内VAS、VNS评分的差异均有统计学意义（Z＝-3.637-98.253，P值均〈0.05）。局部麻醉组内各亚组和神经阻滞组内各亚组穿刺后血尿、血精、尿潴留发生率的差异均有统计学意义（F＝1.347-15.402，P值均〈0.05），但局部麻醉组和神经阻滞组两组间各亚组各种并发症发生率的差异均无统计学意义（P值均〉0.05）。结论与局部麻醉相比，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；但是对于前列腺体积较大的患者，其麻醉效果欠佳。

ObjectiveTo evaluate the anesthetic efficacy of periprostatic nerve block in transrectal ultrasound（TRUS） guided biopsy on different prostate volume.MethodsA total of 568 patients received prostate biopsy in Department of Urology, Subei People＇s Hospital from May 2013 to September 2015 were retrospectively studied. All patients were divided into local anesthesia group and nerve block group according to different way of anesthesia. Then each group was divided into four subgroups（20-40 ml, 〉40-60 ml, 〉60-100 ml and 〉100 ml subgroups） according to different prostate volume range. After being anaesthetized successfully, patients in two groups underwent prostate biopsy, visual analogue scale（VAS） scores, visual numeric scale（VNS）scores and complications were recorded and analyzed. At inter-group and intra-group in local anesthesia group and nerve block group, Mann-Whitney U test of non-parametric analysis and single factor variance analysis were used to compare the VAS scores and the VNS scores respectively, and chi-square test was used to compare the rates of complication.ResultsThe VAS scores of four subgroups： local anesthesia group： 1.9±0.9, 2.8±1.5, 3.8±2.3 and 5.3±2.5; nerve block group： 1.5±0.7, 2.0±0.8, 2.9±1.7 and 4.2±2.0. The VNS scores： local anesthesia group： 3.4±0.6, 2.9±0.6, 2.7±0.5 and 1.6±0.7; nerve block group： 3.7±0.5, 3.3±0.4, 3.0±0.8 and 2.0±0.7. The VAS scores and the VNS scores had significant differences （Z=-3.637-98.253, all P〈0.05） at inter-group or intra-group level. For the complication rates of operation, hematuria, blood, urinary retention were significant differences （F=1.347-15.402, all P〈0.05） at intra-group level. But there were no significant differences at inter-group level（P〉0.05）.ConclusionCompared with local anesthesia, ultrasound guided prostate peripheral nerve block anesthesia has great analgesic effect and high safety, but for patients with a large prostate volumethe analgesic effect is inefficiency.