全凭静脉麻醉与前列腺周围神经阻滞应用于经会阴前列腺穿刺活检的完全随机对照临床研究

Total intravenous anesthesia and periprostatic nerve block for transperineal prostate biopsy:a completely randomized controlled trial

目的:通过对比全凭静脉麻醉与前列腺周围神经阻滞应用于经会阴前列腺穿刺术时患者疼痛程度及不良事件的发生率,探索两种麻醉方式的镇痛效果及安全性。方法:将2017年4月~8月就诊于我院拟行前列腺穿刺的80例患者纳入研究,随机分为观察组(40例)和对照组(40例),观察组接受全凭静脉麻醉(异丙酚复合瑞芬太尼靶控输注),对照组接受前列腺包膜外局部浸润麻醉。80例患者均由同一术者进行经会阴12针系统穿刺,利用长海痛尺评估并记录各阶段疼痛程度,记录手术时间、术中心率、血压的变化、术中术后的不良事件以及术后病理结果,使用SPSS 22.0统计软件进行数据分析。结果:两组患者的年龄、术前血清PSA、手术时间、前列腺癌检出率间差异无统计学意义(P>0.05);全麻组各阶段的疼痛评分低于局麻组,两组患者术中心率、血压均出现轻度波动,术后尿潴留、血尿、呕吐的发生率差异均无统计学意义(P>0.05)。全麻组中16例出现呼吸抑制但均能自行恢复。结论:两种麻醉方式对于经会阴前列腺穿刺术均安全有效。静脉麻醉的镇痛效果及舒适度优于局麻,但术中可能出现呼吸抑制,对患者身体条件的要求较高。

Objective：To compare pain degree and incidence of adverse events between patients experiencing transperineal prostate biopsy under total intravenous anesthesia（TIVA）and periprostatic nerve block（PNB）,and evaluate the analgesic effect and safety of the two anesthesia techniques.Method：From April to August in 2017,a total of 80 patients scheduled to undergo prostate biopsy in department of urology,Changhai Hospital were enrolled in this study.These patients were randomized to receive TIVA（Propofol＋remifentanil TCI）（observation group,n=40）or local anesthesia onto the capsule of the prostate（control group,n=40）,and they were all treated by the same surgeon for transperineal 12-core biopsy.The pain degree of each stage were assessed by＂Changhai Pain Rating Scale＂,and were recorded too.Besides,the operation time,changes of heart rate and blood pressure,intraoperative and postoperative adverse events as well as pathology results were recorded.Data were analyzed using SPSS statistics 22.0.Result：There was no significant difference in the age,preoperative serum PSA,operation time or PCa detection rate between the two groups（P〉0.05）.The pain scores of the observation group were lower in comparison with those of the control group.The heart rate and blood pressure of both groups exhibited mild fluctuation during the operation.Moreover,there showed no significant difference in the incidence of postoperative urinary retention,hematuria or vomiting between the two groups（P〉0.05）.In the observation group,16 patients presented respiratory depression,who later recovered spontaneously.Conclusion：Both anesthetic techniques are effective and safe for the transperineal prostate biopsy.Although analgesic effect and comfort degree of TIVA were better than those of local anesthesia,TIVA could lead to respiratory depression,requiring a better physical condition for the patient.