麻醉方式对老年膀胱肿瘤患者TURBT临床效能观察

Clinical Efficacy of Anesthesia on TURBT in Elderly Patients with Bladder Tumor

目的:探索不同麻醉方式对老年膀胱肿瘤患者经尿道膀胱肿瘤切除术(TURBT)的临床效能。方法:选取2020年12月—2022年12月202例于菏泽市中医医院治疗的老年膀胱肿瘤患者为研究对象,按照手术麻醉方式分组,其中A组(采用静脉全身麻醉)66例,B组(采用硬膜外麻醉)62例,C组(采用硬膜外麻醉复合超声下闭孔神经阻滞)74例。所有患者均行TURBT治疗,综合比较三组手术一般情况(手术时间、术中出血量、术后住院时间)、并发症发生情况、炎症因子水平。结果:三组手术时间、术中出血量差异均无统计学意义(P>0.05);C组术后住院时间显著短于A组和B组(P<0.05),A组与B组术后住院时间差异无统计学意义(P>0.05);三组膀胱穿孔、膀胱出血发生率差异均无统计学意义(P>0.05),C组闭孔神经反射发生率显著低于A组和B组(P<0.05),A组和B组闭孔神经反射发生率差异无统计学意义(P>0.05);术后C组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)等炎症因子水平均显著低于A组和B组(P<0.05)。结论:硬膜外麻醉复合超声下闭孔神经阻滞可预防TURBT闭孔神经反射,缩短术后住院时间,降低术后炎症反应。

Objective:To explore the clinical efficacy of transurethral resection of bladder tumer(TURBT)with different anesthetic methods in elderly patients with bladder tumor.Method:A total of 202 elderly patients with bladder tumor treated in Heze Traditional Chinese Medicine Hospital from December 2020 to December 2022 were selected and divided into three groups according to surgical anesthesia.There were 66 cases in group A(intravenous general anesthesia),62 cases in group B(epidural anesthesia)and 74 cases in group C(epidural anesthesia combined with obturator nerve block under ultrasound).All patients were treated with TURBT,and the general operation conditions(operation time,intraoperative blood loss,postoperative hospitalization time),complications and perioperative inflammatory factors were compared among the three groups.Result:There were no significant differences in operation time and intraoperative blood loss among the three groups(P>0.05),the postoperative hospital stay in group C was significantly shorter than those in group A and group B(P<0.05),there was no significant difference in postoperative hospital stay between group A and group B(P>0.05).There were no significant differences in the incidence of bladder perforation and bladder bleeding among the three groups(P>0.05),the incidence of obturator nerve reflex in group C was significantly lower than those in group A and group B(P<0.05),there was no significant difference in the incidence of obturator nerve reflex between group A and group B(P>0.05).The levels of inflammatory factors(TNF-α,IL-6,IL-8)after operation in group C were significantly lower than those in group A and group B(P<0.05).Conclusion:Epidural anesthesia combined with obturator nerve block under ultrasound can prevent TURBT obturator nerve reflex,shorten postoperative hospital stay,and reduce postoperative inflammatory reaction.