超声引导下闭孔神经阻滞对膀胱肿瘤患者术后疼痛、应激反应及血清炎症因子的影响

Effects of ultrasound-guided obturator nerve block on postoperative pain,stress response and serum inflammatory factors in patients with bladder tumors

目的探讨超声引导下闭孔神经阻滞(ONB)对膀胱肿瘤电切术患者术后疼痛、应激反应及血清炎症因子的影响。方法选取2021年1月至2022年12月于该院接受经尿道膀胱肿瘤电切术的100例患者为研究对象,采用随机数字表法分为观察组和对照组,每组50例。对照组给予喉罩全身麻醉,观察组给予超声引导下ONB+喉罩全身麻醉。采用视觉模拟疼痛(VAS)评分评估两组术后6、12、24 h的疼痛程度。比较两组麻醉前及麻醉后2 h血清肾上腺素(E)、去甲肾上腺素(NE)及肾上腺皮质激素(Col)水平。比较两组手术前及手术后3 d血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及超敏C反应蛋白(hs-CRP)水平。记录两组膀胱出血、穿孔、闭孔神经反射等手术并发症及麻醉不良反应发生情况。结果两组不同时间点VAS评分比较,差异有统计学意义(P<0.05);观察组VAS评分低于对照组(P<0.05);两组VAS评分随时间变化趋势差异有统计学意义(P<0.05)。观察组麻醉后2 h的血清E、NE及Col水平均较对照组降低(P<0.05)。两组手术后3 d血清TNF-α、IL-6及hs-CRP水平较手术前显著升高(P<0.05),观察组手术后3 d血清TNF-α、IL-6及hs-CRP水平较对照组下降(P<0.05)。观察组手术并发症发生率较对照组降低(P<0.05);两组麻醉不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下ONB对经尿道膀胱肿瘤电切术患者术后镇痛效果较好,应激反应轻,利于减轻术后炎症反应。

Objective To investigate the effect of ultrasound-guided obturator nerve block(ONB)on postoperative pain,stress response and serum inflammatory factors in the patients with bladder tumors.Methods A total of 100 patients receiving transurethral resection of bladder tumors in this hospital from January 2021 to December 2022 were selected and divided into the observation group and control group by adopting the random number table method,50 cases in each group.The control group was given laryngeal mask general anesthesia,and the observation group was given ultrasound-guided ONB plus laryngeal mask general anesthesia.The VAS score was used to assess the pain degree at 6,12 and 24 h after surgery in the two groups.The levels of serum epinephrine(E),norepinephrine(NE)and adrenocortical hormone(Col)before anesthesia and at 2 h after anesthesia were compared between the two groups.The levels of serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and hypersensitivity C-reactive protein(hs-CRP)before anesthesia and on 3 d after anesthesia were compared between the two groups.The occurrence of surgical complications and anesthetic adverse reactions such as bladder bleeding,perforation and obturator nerve reflex was recorded in the two groups.Results The VAS scores at different time points had statistical difference between the two groups(P<0.05),the VAS score in the observation group was lower than that in the control group(P<0.05),and the trend of VAS scores change with time had statistical difference between the two groups(P<0.05).The serum E,NE and Col levels at 2 h after anesthesia in the observation group were lower than those in the control group(P<0.05).The serum TNF-α,IL-6 and hs-CRP levels on postoperative 3 d in the two groups were significantly increased compared with those before anesthesia(P<0.05),while the serum TNF-α,IL-6 and hs-CRP levels on postoperative 3 d in the observation group were decreased compared with those in the control group(P<0.05).The incidence rate of surgical complications in the observation group was decreased compared with that in the control group(P<0.05),and there was no statistically significant difference in the incidence rate of adverse anesthesia reactions between the two groups(P>0.05).Conclusion Ultrasound-guided ONB has good postoperative analgesia effect in the patients undergoing transurethral electrocision of bladder tumors,and the stress response is mild,which is conducive to reduce postoperative inflammation reaction.