超声引导下阴部神经阻滞在宫腔镜手术中的应用

Application of ultrasound-guided pudendal nerve block in hysteroscopic surgery

目的比较超声引导下阴部神经阻滞麻醉和静脉复合麻醉用于宫腔镜手术的麻醉效果及镇痛效果。方法将择期行宫腔镜手术的患者40例纳入本研究,并将其随机分为超声引导下阴部神经组(PNB组)和静脉麻醉组(IA组),每组20例。手术开始前,PNB组患者实施超声引导下阴部神经阻滞, IA组患者实施静脉麻醉,观察手术前(T0)、麻醉后3 min(T1)、手术开始时(T2)、手术后10 min(T3)、手术后1 h(T4)MAP、HR、SpO2的变化,观察术中Ramsay镇静评分以及术后6 h(T5)、术后12 h(T6)、术后24 h(T7)的VAS评分,记录术后并发症及患者满意度情况。结果在T1时点,IA组MAP明显低于术前(P<0.05);在T2时,IA组HR明显高于术前,提示短暂刺激较大(P<0.05);在T1时点,IA组SpO2较术前降低,2组比较差异有统计学意义(P<0.05)。术中Ramsay镇静评分:PNB组镇静满意,评分均为2~4分,IA组均为6分。PNB组的VAS评分在T5、T6两个时点明显低于IA组(P<0.05)。PNB组术后2例出现恶心呕吐并发症(10%),IA组有8例(40%),PNB术后3例出现头晕并发症(15%),IA组有6例(30%),2组比较差异有统计学意义(P<0.05)。结论超声引导下阴部神经阻滞用于宫腔镜手术镇痛效果好,并发症少,值得推广。

Objective To compare the anesthetic effect and analgesic effect of ultrasound-guided pudendal nerve block anesthesia and intravenous anesthesia in hysteroscopic surgery.Methods 40 patients undergoing elective hysteroscopy were included in this study and the patients were randomly divided into ultrasound-guided pudendal nerve group(PNB group,n=20)and intravenous anesthesia group(IA group,n=20).Before operation,pudendal nerve block was performed under ultrasound guidance in PNB group,and intravenous anesthesia was performed in IA group.The changes of MAP,HR and SpO2 were observed before operation(T0),three minutes after anesthesia(T1),at the beginning of operation(T2),10 minutes after operation(T3)and one hour after operation(T4).Ramsay sedation score and operation were observed.The postoperative complications and patient satisfaction were recorded at 6 h(T5),12 h(T6)and 24 h(T7)after surgery.Results MAP in IA group was significantly lower than that before operation at T1(P<0.05),and HR in IA group was significantly higher than that before operation at T2(P<0.05),and SPO2 in IA group was significantly lower than that before operation at T1(P<0.05).Sedation score of Ramsay and sedation score of group PNB were all 2~4 and sedation satisfaction was 6,while group IA was sedation score.The VAS score of PNB group at T5 and T6 was significantly lower than that of IA group(P<0.05).Postoperative nausea and vomiting occurred in two cases(5%)in PNB group,8 cases(40%)in IA group,3 cases(15%)in PNB group,and 6 cases(30%)in IA group.The differences between the two groups were statistically significant(P<0.05).Conclusion Ultrasound-guided pudendal nerve block has a good analgesic effect and fewer complications in hysteroscopic surgery,which is worth popularizing.