超声引导下骶管阻滞用于日间在直肠超声引导经会阴途径穿刺活检术的临床研究

Advantages of ultrasound-guided caudal epidural block over TIVA for transrectal ultrasound guided transrectal prostate biopsy

目的评价超声引导下骶管阻滞在直肠超声探头引导下经会阴前列腺穿刺活检术中应用的安全性和有效性。方法选择60例行直肠超声探头引导经会阴前列腺穿刺活检术的老年患者,按随机数字表分为超声引导骶管阻滞组(A组,n=30)和全凭静脉麻醉组(B组,n=30)。A组患者在轻度镇静镇痛下(咪达唑仑0.01 mg/kg,舒芬太尼0.05μg/kg)接受超声引导下骶管阻滞,骶管给药0.33%罗哌卡因15 ml;B组患者接受保留自主呼吸的全凭静脉麻醉。记录两组患者入手术室时(T1)、手术开始前即刻(T2)和手术结束后(T3)的动脉压(MAP)、心率(HR)、呼吸频率(BR)和脉搏氧饱和度(SPO_2),于入手术室前、术后2、8、24 h评估简易精神状态检查表(MMSE),观察记录不良反应和外科满意度。结果 B组T2时MAP、HR和BR值均较T1时显著下降(P<0.05),且MAP、HR和BR值低于同时点A组(P<0.05)。B组患者MMSE值在术后2 h(25.66±1.71)、8 h(26.13±1.52)较入手术室前时(29.46±0.71)显著降低(P<0.05),且明显低于A组(2h:27.96±1.09,8h:29.01±0.77,P<0.05)。B组术中麻黄碱(13%)及面罩手控辅助通气(20%)使用率较高。两组其他不良反应发生情况比较差异无统计学意义(P>0.05)。结论直肠超声探头引导经会阴前列腺穿刺活检术采用超声引导下骶管阻滞,患者生命体征平稳,符合日间手术快速康复要求,可在日间手术安全使用。

Objective To compare the safety and efficacy of the caudal block and Total Intravenous Anesthesia （TIVA） for transrectal ultrasound （TRUS） guided prostate biopsy. Methods 60 elderly patients with transrectal ultrasound guided transperineal prostate biopsy were randomized into Group A and Group B. Patients in Group A received ultrasound guided caudal block （0. 33% ropivacaine 15 ml） and patients in Group B received TIVA. In operation room （ T1 ）, immediately befbre operation （T2） and at the end of opera- tion （T3）, mean artery pressure （MAP） , heart rate （HR） , breathing rate （BR） and pulse oxygen saturation （SpO2 ） were recorded. The patients in two groups were rated the level of mini-mental state examination （MMES） at 2 h, 8 h and 24 h after operation. Complications during the whole study period were also evalua- ted. Results The values of MAP, HR and BR of TI in group B were significantly lower than those at T2 （P〈0.05）, and were lower than those in the group A （P〈0.05）. The MMSE value in group A [2 h （25.66 e 1.71 ） and 8 h （26. 13 ± 1.52） I was significantly higher than that in group B [2 h （27.96 ± 1.71 ） and 8 h （29.01 ± 0. 77） ] at after operation （P 〈 0. 05 ）. The rate of usage of ephedrine （ 13% ） and assisted ventilation （20%） in group B was higher. No significant differences were detected in side effects between the two groups. Conclusions Caudal block provides better anesthesia than TIVA for TRUS guided prostate biopsy without an increase of side effects, and it may be safely used during ambulatory surgery.