全身麻醉和腰麻联合闭孔神经阻滞在膀胱肿瘤合并糖尿病患者TURBT中的对比研究

Comparison of Transurethral Resection of Bladder Tumor under General Anesthesia or Spinal Anesthesia Combined with Block Anesthesia of the Obturator Nerve in Patients with Bladder Tumor Complicated with Diabetes

目的:比较全身麻醉和腰麻联合闭孔神经阻滞在膀胱肿瘤合并糖尿病患者经尿道膀胱肿瘤电切术(TURBT)中的效果。方法:选取本院2018年12月-2020年5月住院手术治疗的膀胱肿瘤合并糖尿病患者68例,随机分为对照组(n=34)和观察组(n=34),分别在全身麻醉或腰麻联合闭孔神经阻滞下,行经尿道膀胱肿瘤电切术。比较两组患者术中闭孔神经反射发生率、手术时间、出血量、围手术期血糖控制情况和术后恢复情况。结果:两组患者闭孔神经反射率、手术时间和出血量比较差异均无统计学意义(P>0.05)。观察组患者术中和手术结束时的血糖水平明显优于对照组(P<0.05)。观察组患者肺部感染发生率明显低于对照组,肠道功能恢复时间明显早于对照组(P<0.05)。结论:膀胱肿瘤合并糖尿病患者采用腰麻联合闭孔神经阻滞经尿道膀胱肿瘤电切术中,闭孔神经反射和膀胱损伤的发生率与采用全身麻醉相当,但对围手术期中血糖水平影响和术后恢复明显优于全身麻醉,值得临床推广应用。

Objective:To compare the effect of transurethral resection of bladder tumor (TURBT) under general anesthesia or spinal anesthesia combined with block anesthesia of the obturator nerve in patients with bladder tumor complicated with diabetes.Method:From December 2018 to May 2020,a total of 68 patients with bladder tumor complicated with diabetes were included and randomized into the control group (n=34) and the observation group (n=34).Patients received transurethral resection of bladder tumor under general anesthesia or spinal anesthesia combined with block anesthesia of the obturator nerve,respectively.The incidence of obturator nerve reflex during operation,operation time,amount of bleeding,blood glucose level control and postoperative recovery in both groups were compared.Result:There were no significantly differences in the incidence of the obturator nerve reflex,operation time and amount of bleeding between the two groups (P>0.05).The blood glucose levels during and after surgery were significantly better controlled in the observation group than that in the control group (P<0.05).Compared with the control group,the patients in the observation group had significantly lower pulmonary infection rates and earlier recovery time of intestinal function (P<0.05).Conclusion:For patients with bladder tumor combined with diabetes,transurethral resection of bladder tumor under spinal anesthesia combined with block anesthesia of the obturator nerve has comparable rate of the obturator nerve emission and bladder injury,but better blood glucose level control and postoperative recovery.