超声引导下闭孔神经阻滞复合静脉麻醉在经尿道膀胱肿瘤电切术中的应用效果观察

Application effect of obturator nerve block under B-ultrasound localization combined with intravenous anesthesia in transurethral resection of bladder tumor

目的:探讨超声引导下闭孔神经阻滞(ONB)复合静脉麻醉在经尿道膀胱肿瘤电切术(TURBT)术中的应用效果。方法:选取膀胱肿瘤患者66例,分为静脉组(n=30)和ONB组(n=36),比较两组手术相关指标和麻醉不良反应,比较两组麻醉诱导前(T_(0))、给药后10 min(T_(1))、麻醉后1 h(T_(2))和麻醉后2 h(T_(3))的血流动力学水平,记录心率(HR)和呼吸(RR)水平变化,比较两组T_(0)和T_(3)应激激素水平差异。结果:ONB组麻醉时间高于静脉组,手术时间、术中出血量和闭孔神经反射发生率低于静脉组(均P<0.05);T_(0)期两组心率(HR)和呼吸(RR)比较无统计学差异(均P>0.05),T_(1)、T_(2)期HR和RR均低于T_(0)期,但ONB组高于静脉组(均P<0.05);T_(3)期两组皮质醇(COR)、肾上腺素(E)和去甲肾上腺素(NE)均高于T_(0)期,且ONB组低于静脉组(均P<0.05);ONB组术后总不良反应发生率为8.33%与静脉组13.33%比较无统计学差异(P>0.05)。结论:超声引导下ONB复合静脉麻醉在TURBT术中有良好应用效果,可较好维持血流动力学和应激水平稳定,并降低术中闭孔神经反射发生率。

Objective:To explore the application effect of obturator nerve block(ONB)under B-ultrasound localization combined with intravenous anesthesia in transurethral resection of bladder tumor(TURBT).Methods:A total of 66 patients with bladder tumors were enrolled.According to different anesthesia methods,they were divided into intravenous group(30 cases)and ONB group(36 cases).The surgical related indexes and adverse anesthesia reactions between the two groups were compared.The hemodynamics levels before anesthesia induction(T_(0)),at 10 minutes after administration(T_(1)),1 hours after anesthesia(T_(2))and 2 hours after anesthesia(T_(3))were compared between the two groups.The changes of heart rate(HR)and respiration rate(RR)were recorded.The differences in levels of stress hormones at T_(0)and T_(3)were compared between the two groups.Results:The anesthesia time in ONB group was longer than that in intravenous group,operating time,intraoperative blood loss and incidence of obturator nerve reflex were lower than those in intravenous group(all P<0.05).At T_(0)and T_(3),there was no significant difference in HR and RR between the two groups(all P>0.05).HR and RR at T_(1),T_(2)were lower than those at T_(0)in both groups,which were higher in ONB group than in intravenous group(all P<0.05).The levels of cortisol(COR),epinephrine(E)and norepinephrine(NE)at T_(3)were higher than those at T_(0)in both groups,which were lower in ONB group than in intravenous group(all P<0.05).There was no significant difference in total incidence of adverse reactions(tachycardia,nausea,vomiting,hypotension)between ONB group and intravenous group(8.33%vs.13.33%,P>0.05).Conclusion:The application effect of ONB under B-ultrasound localization combined with intravenous anesthesia is good in TURBT,which can better maintain the stability of hemodynamics and stress level,and reduce the incidence of intraoperative obturator nerve reflex.