经尿道前列腺电切术术后经静脉与经硬膜外镇痛方法的比较

The front urethra gland cutting after approved by vein and the comparison of epidural analgesia

目的:比较经静脉与经硬膜外两种不同方式对经尿道前列腺电切术后的镇痛效果。方法:选择经尿道前列腺电切术患者60例,分为A组和B组,每组30例。A组给予甲氧氯普胺30 mg+芬太尼1 mg+0. 9%氯化钠注射液至100 m L,静脉滴注镇痛; B组给予罗哌卡因200 mg+吗啡2 mg+0. 9%氯化钠注射液至100 m L,硬膜外镇痛。两组均以每小时2 m L的药液量注入。观察术后3、5、7、12、24、36、48 h的疼痛(VAS)评分和镇静(Ramsay)评分,以及术后认知功能障碍、恶心呕吐、呼吸抑制、膀胱痉挛、下肢乏力或麻木、低血压的例数。结果:两组患者术后VAS评分和Ramsay评分比较,差异无统计学意义。A组恶心呕吐发生率明显高于B组(P <0. 05)。B组患者术后低血压的发生率明显高于A组(P <0. 05)。A组膀胱痉挛发生率明显高于B组。与术前1 d比较,术后不同时点B组简易精神智能状态量表(MMSE)评分比较,差异无统计学意义,术后7 h,24 h,A组MMSE评分降低(P <0. 05)。与A组比较,术后7 h,B组MMSE评分升高(P <0. 01)。B组术后认知功能障碍低于A组(P <0. 05)。结论:术后经静脉镇痛可避免低血压。经硬膜外镇痛可减少认知功能障碍、恶心呕吐例数,避免呼吸抑制、嗜睡和膀胱痉挛。

Objective: To compare the vein and the epidural two different analgesic methods on the effect of transurethral prostatic electricity cut method. Methods: All 60 patients with transurethral prostatic electricity cut method,aged 60 to 80 years old,with metoclopramide 30 mg + fentanyl 1 mg + 0. 9% NACL physiological saline to 100 m L of intravenous analgesia group( group A) and ropivacaine 200 mg + morphine 2 mg + 0. 9% Na CL physiological saline to 100 m L of epidural analgesia group( group B),each group 30. Both groups of 2 m L per hour amount of liquid injection. Observation of postoperative 3,5,7,12,24,36,48 h VAS pain score and Ramsay sedation scores,and postoperative cognitive dysfunction,nausea,vomiting,respiratory depression,bladder spasm,the number of cases of lower limb weakness or numbness,low blood pressure. Results: Two groups of patients with postoperative pain VAS score and Ramsay sedation scores no statistical significance. The incidence of nausea and vomiting in group A is significantly higher than group B( P < 0. 05). The incidence of postoperative hypotension in patients with B group was obviously higher than that of group A( P < 0. 05). The incidence of bladder spasm A group was obviously higher than that of group B. Postoperative different points compared with preoperative 1 d,MMSE score no statistically significant differences in group B,7 h,24 h,MMSE score lower group A( P < 0. 05). Compared with group A,7 h postoperatively,MMSE score rise in group B( P < 0. 01). Postoperative cognitive dysfunction group B is lower than group A( P < 0. 05). Conclusion: Postoperative intravenous analgesia can avoid low blood pressure. After the epidural analgesia reduce cognitive dysfunction,the number of cases of nausea and vomiting,avoid respiratory depression,lethargy,bladder spasm.