痔上黏膜环切吻合术麻醉方式的新探讨

Anew study on the method of anesthesia in procedure for prolapse and hemorrhoids

目的观察用于痔上黏膜环切吻合术(PPH)的3种椎管内麻醉方式的镇痛效果和不良反应,以探讨最佳的麻醉方法。方法选取2016年在我院实施PPH的患者90例,随机分为腰硬联合麻醉(A)组、单点穿刺持续硬膜外阻滞麻醉(B)组、两点穿刺持续硬膜外阻滞麻醉(C)组,每组30例(n=30)。分别记录每组术前、术中、术后的血压、心率、血氧饱和度;将麻醉效果分级,记录麻醉效果、排尿时间和尿潴留的发生情况。结果 A组和C组麻醉效果明显优于B组(P<0.05);B组和C组的排尿时间均较A组短(P<0.05);A组尿潴留的发生率明显高于B组和C组(P<0.05)。结论腰硬联合麻醉和两点持续硬膜外阻滞麻醉下行PPH,麻醉效果好,牵拉反应出现少,均能满足PPH手术,但后者以恢复快和尿潴留出现少等优点,值得临床推广。

Objective To observe the analgesic effect and adverse reactions of three kinds of spinalanesthesia methods for procedure for prolapse and hemorrhoidsand explore the preferred anesthesia method.Methods Ninety patients with PPH were enrolled in our hospital in 2016. They were randomly divided into threegroups（30 patients in each group）：group A（combined spinal and epidural anesthesia）,group B（one point ofpuncture continued epidural anesthesia）,and group C（two points of puncture continued epidural anesthesia）. Theblood pressure,heart rate and blood oxygen saturation were recorded before operation,intraoperative and postoper-ative processes. The anesthetic effect was graded,and the anesthesia effect,urination time and urinary retentionwere recorded. Results The anesthesia effect of the group A and the group C was significantly better than that ofthe group B（P 0.05）. The urination time of the group B and the group C was shorter than that of the group A（P 0.05）. The incidence of urinary retention in the group A was significantly higher than that in the group Bandthe group C（P 0.05）. Conclusions The PPH can be completed under the combined spinal and epiduralanesthesia and the two points of puncture continued epidural anesthesia with anesthesia effect and less tractionreaction,but the latter will be a preferred option with the advantages of fast renewal and less urinary retention. It isworthy to be promoted widely.