两种麻醉方式对经尿道膀胱肿瘤电切术患者闭孔神经反射和术后恢复的影响

Effect of two types of anesthesia on obturator nerve reflex and postoperative recovery in patients undergoing transurethral resection for bladder tumors

目的观察超声引导下改良闭孔神经阻滞(ONB)联合瑞马唑仑麻醉对经尿道膀胱肿瘤电切术(TURBT)患者闭孔神经反射(ONR)和术后恢复的影响。方法选取2019年6月至2021年6月秦皇岛医院收治的行TURBT术的膀胱肿瘤患者100例,根据ONB方式的不同将其分为常规组(椎管内麻醉+传统ONB麻醉)50例,超声组(椎管内麻醉+超声引导下改良ONB联合瑞马唑仑麻醉)50例。比较两组围术期指标、不同时间点血流动力学指标、术中ONR发生情况、并发症、麻醉不良反应。结果与常规组比较,超声组ONB时间、手术时间、尿管留置时间、住院时间均缩短,术中出血量减少(P<0.05)。给药后30 min(T1)、手术结束时(T2)时与常规组比较,超声组平均动脉压(MAP)、氧饱和度(SaO 2)升高(P<0.05)。与常规组比较,超声组术中ONR、膀胱出血发生率降低,术后心动过缓、恶心呕吐发生率降低(P<0.05)。结论超声引导下改良ONB联合瑞马唑仑麻醉可有效改善TURBT术围术期指标,减少术中ONR、膀胱出血,且对血流动力学影响小,术后麻醉不良反应少。

Objective To observe the effects of ultrasound-guided modified obturator nerve block(ONB)combined with remazolam anesthesia on obturator nerve reflex(ONR)and postoperative recovery of patients with transurethral resection of bladder tumors(TURBT).Methods One hundred patients with bladder tumor admitted to Qinhuangdao Hospital from June 2019 to June 2021 were treated with TURBT.They were divided into conventional group(intraspinal anesthesia+traditional ONB anesthesia)and ultrasound group(intraspinal anesthesia+improved ONB combined with remidazolam anesthesia under ultrasound guidance)with 50 cases in each according to different ONB methods.Perioperative indexes,hemodynamic indexes at different time points,intraoperative ONR occurrence,complications and adverse anesthesia reactions were compared between the two groups.Results Compared with conventional group,ONB time,operation time,catheter indwelling time and hospital stay were shortened,and intraoperative blood loss was decreased in ultrasound group(P<0.05).Compared with the conventional group at 30 min after administration(T1)and at the end of operation(T2),the mean arterial pressure(MAP)and oxygen saturation(SaO 2)were increased in the ultrasound group(P<0.05).Compared with the conventional group,the incidence of ONR and bladder bleeding was decreased,and the incidence of postoperative bradycardia,nausea and vomiting were decreased in the ultrasound group(P<0.05).Conclusions Ultrasound-guided modified ONB combined with remazolam anesthesia can effectively improve perioperative indexes of TURBT,reduce intraoperative ONR and bladder bleeding,and have little influence on hemodynamics with few postoperative adverse anesthesia reactions.