超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中的效果

Evaluation on the application effect of ultrasound-guided obturator nerve block in transurethral resection of bladder tumor

目的探讨超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用效果。方法采用随机数字表法对80例于2018年4月至2019年3月我院收治的膀胱肿瘤患者进行分组,每组各40例,对照组单纯在腰麻-硬脊膜外阻滞基础上行膀胱肿瘤电切术,观察组在超声引导下闭孔神经阻滞基础上行经尿道膀胱肿瘤电切术,对患者入室、切皮前、切皮时、术中30 min、术中60 min、术中90 min、拔管后30 min的心率(HR)、平均动脉压(MAP)的变化情况、术前与术后的动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、疼痛(VAS)评分的变化情况、电切时间、镇痛持续时间、麻醉起效时间、拔管时间、苏醒时间、留置导尿管时间、住院时间、术中出血量、术后1年的复发率情况、闭孔神经反射发生率情况、膀胱穿孔发生率情况进行观察。结果入室、切皮前、术中30 min、术中60 min、术中90 min,两组患者的HR与MAP差异无统计学意义(P>0.05),切皮时、拔管后30 min,观察组的HR与MAP明显低于对照组,差异有统计学意义(P<0.05);术前,两组患者的SaO_(2)、PaO_(2)、PaCO_(2)水平、VAS评分比较,差异无统计学意义(P>0.05),术后观察组的SaO_(2)、PaO_(2)水平明显高于对照组,PaCO_(2)水平、VAS评分明显低于对照组,差异有统计学意义(P<0.05);观察组的镇痛持续时间明显长于对照组,其他各项时间指标明显短于对照组,术中出血量明显少于对照组,术后1年的复发率、闭孔神经反射发生率、膀胱穿孔发生率明显低于对照组,差异有统计学意义(P<0.05)。结论超声引导下闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用具有良好的临床效果。

Objective To investigate the application effect of ultrasound-guided obturator nerve block in transurethral resection of bladder tumor.Methods A total of 80 patients with bladder tumor admitted to our hospital from April 2018 to March 2019 were divided into the control group(n=40)and the observation group(n=40)according to the random number table method.The control group was simply treated with resection of bladder tumor based on spinal anesthesia-epidural block,while the observation group was treated with transurethral resection of bladder tumor based on ultrasound-guided obturator nerve block.The changes of heart rate(HR)and mean arterial pressure(MAP)before entering the operation room,before skin incision,during skin incision,30 min,60 min,90 min during operation and 30 min after extubation were observed.The changes of arterial oxygen saturation(SaO_(2)),arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),pain(VAS)scores before and after the operation were observed.The electric resection time,analgesia duration,anesthesia onset time,extubation time,recovery time,indwelling catheter time,hospitalization time,intraoperative hemorrhage volume,1-year postoperative relapse rate,incidence of obturator nerve reflex and incidence of bladder perforation were observed.Results There were no statistically significant differences in HR and MAP between the two groups of patients before entering the operation room,before skin incision,and 30 min,60 min and 90 min during operation(P>0.05).HR and MAP in the observation group were significantly lower than those in the control group at the time of skin incision and 30 min after extubation,with statistically significant differences(P<0.05).Before operation,there were no statistically significant differences in SaO_(2),PaO_(2)and PaCO_(2)levels and VAS scores between the two groups of patients(P>0.05).After operation,the levels of SaO_(2)and PaO_(2)in the observation group were significantly higher than those in the control group,while the levels of PaCO_(2)and VAS scores in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The analgesia duration in the observation group was significantly longer than that in the control group,and other time indices were significantly shorter than those in the control group.The intraoperative hemorrhage volume was significantly less than that of the control group.And 1-year postoperative relapse rate,incidence of obturator nerve reflex and incidence of bladder perforation were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusion Ultrasound-guided obturator nerve block has a good clinical efficacy in transurethral resection of bladder tumor.