本文選題：閉孔神經(jīng)阻滯 + 超聲引導(dǎo)��； 參考：《臨床泌尿外科雜志》2016年12期

【摘要】：目的:比較腰硬聯(lián)合麻醉和腰硬聯(lián)合麻醉加超聲引導(dǎo)下閉孔神經(jīng)阻滯在膀胱側(cè)壁及三角區(qū)附近腫瘤經(jīng)尿道膀胱腫瘤等離子電切術(shù)(TUPKR-Bt)中的臨床效果。方法:回顧性研究2012年1月1日~2015年10月31日在我院泌尿外科行經(jīng)尿道膀胱腫瘤電切術(shù)的98例膀胱側(cè)壁腫瘤患者。其中48例患者單獨(dú)行腰硬聯(lián)合麻醉(CSEA組),50例患者行腰硬聯(lián)合麻醉加超聲引導(dǎo)下閉孔神經(jīng)阻滯(CSEA+O組)。結(jié)果:CSEA+O組的腫瘤切除時(shí)間(15.38±7.09)min顯著短于CSEA組的(19.45±5.70)min,閉孔神經(jīng)反射發(fā)生率及膀胱穿孔率顯著少于CSEA組(2%vs.39.6%;0vs.10.4%),血紅蛋白下降水平(0.5±0.37)g/dL顯著小于CSEA組(0.8±0.43)g/dL,膀胱刺激征發(fā)生率顯著少于CSEA組(24%vs.64.6%),留置尿管時(shí)間和住院時(shí)間顯著短于CSEA組,隨訪期間腫瘤復(fù)發(fā)率低于CSEA組(8%vs.22.9%);輸血率和術(shù)后1年腫瘤復(fù)發(fā)率兩組差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:超聲引導(dǎo)下閉孔神經(jīng)阻滯應(yīng)用于TUPKR-Bt患者中,可以有效減少閉孔神經(jīng)反射的發(fā)生,使切除更徹底和安全,減少術(shù)中出血,縮短住院時(shí)間,減少腫瘤復(fù)發(fā)。
[Abstract]:Objective: to compare the clinical effects of combined spinal-epidural anesthesia and combined spinal-epidural anesthesia with ultrasound guided obturator nerve block in the treatment of bladder cancer by transurethral resection of bladder tumor by transurethral plasma resection (TUPKR-Btt). Methods: 98 patients with lateral wall tumor of bladder underwent transurethral resection of bladder tumor from January 1, 2012 to October 31, 2015. Among them, 48 cases were treated with CSEA alone and 50 cases were treated with combined spinal-epidural anesthesia and ultrasound guided obturator nerve block (CSEA O group). Results the resection time was 15.38 鹵7.09)min significantly shorter than that in CSEA group (19.45 鹵5.70 min). The incidence of obturator nerve reflex and bladder perforation was significantly lower than that in CSEA group (2vs.39.60vs.10.4). The decreased level of hemoglobin was 0.5 鹵0.37)g/dL significantly lower than that of CSEA group (0.8 鹵0.43g / dL), and the incidence of bladder irritation was significantly lower. In CSEA group, 24vs.64.6, the time of indwelling urinary catheter and the length of stay were significantly shorter than that of CSEA group. The recurrence rate of tumor in CSEA group was lower than that in CSEA group, but there was no significant difference between the two groups in blood transfusion rate and tumor recurrence rate in one year after operation. Conclusion: Ultrasound-guided obturator nerve block in TUPKR-Bt patients can effectively reduce the occurrence of obturator nerve reflex, make resection more complete and safe, reduce intraoperative bleeding, shorten hospital stay, and reduce tumor recurrence.
【作者單位】： 暨南大學(xué)附屬第一醫(yī)院泌尿外科;南方醫(yī)科大學(xué)臨床解剖學(xué)研究所;暨南大學(xué)附屬第一醫(yī)院麻醉科;
【基金】：廣東省自然科學(xué)基金項(xiàng)目(編號(hào)S2013010016503) 暨南大學(xué)第一臨床醫(yī)學(xué)院科研培育專(zhuān)項(xiàng)基金項(xiàng)目(編號(hào)20136000Z150360)
【分類(lèi)號(hào)】：R737.14

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