超声引导下腹股沟径路闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用

目的 比较超声引导下腹股沟径路闭孔神经阻滞和传统神经刺激器定位闭孔神经阻滞预防闭孔神经反射的效果。 方法 选取我院2011 年7 月- 2012 年11 月经尿道膀胱肿瘤电切术的患者48 例，美国麻醉医师协会（American Society of Anesthesiology，ASA） 分级Ⅰ或Ⅱ级，采用随机数字表法，将其随机均分为两组：超声引导组（U 组，n=24） 和神经刺激器组（N 组，n=24）。膀胱肿瘤位于单侧或双侧闭孔神经支配区域，其中17 例需行双侧闭孔神经阻滞。闭孔神经阻滞前后分别测定阻滞侧大腿内收肌力量。记录每侧闭孔神经阻滞穿刺尝试次数、操作时间及两种闭孔神经阻滞方法成功率及并发症发生情况等。 结果 U 组均为1 次尝试，N 组有18 侧为1 次尝试，13 侧为2 次尝试以上，两组间差异有统计学意义（P ＜ 0.05） ；U 组闭孔神经阻滞操作时间明显少于N 组（P ＜ 0.05） ；两组闭孔神经阻滞前后测定的阻滞侧大腿内收肌力量及阻滞成功率比较无统计学意义（P ＞ 0.05） ；两组患者均未出现局麻药中毒、术后闭孔神经支配区域痛性感觉异常及闭孔神经损伤等情况。 结论 与传统神经刺激器定位比较，超声引导下闭孔神经阻滞定位准确，试穿次数少，操作时间短，安全有效。

Application of ultrasound-guided inguinal obturator nerve block in transurethral electric excision of bladder tumor

Objective To compare the effects of ultrasound-guided inguinal obturator nerve block and traditional nerve stimulator on preventing obturator nerve reflex. Methods Forty-eight patients with （American Society of Anesthesiology, ASA） Ⅰ or Ⅱ aged 37-81 years who underwent transurethral electric excision of bladder tumor in our hospital from July 2011 to November 2012 were randomly divided into ultrasound-guided group （group U, n=24） and nerve stimulator group （group N, n=24）. The bladder tumor was located in unilateral or bilateral obturator nerve-innervated area. Bilateral obturator nerve was blocked in 17 patients. The thigh adductor muscle strength in blocked side was measured before and after obturator nerve block. Frequencies of obturator nerve block puncture in each side, operational time, block success rate and complications were recorded. Results Each side was punctured once in group U, 18 sides were punctured once and 13 sides were punctured more than two times in group N （P 〈 0.05）. The operational time was significantly shorter in group U than in group N （P 〈 0.05）. No significant difference was found in the thigh adductor muscle strength and block success rate between the two groups before and after block （P 〉 0.05）. No local anesthetic toxicity, regional pain and obturator nerve injury occurred in two groups. Conclusion Ultrasound-guided inguinal obturator nerve block is more accurate, safe and effective in locating obturator nerve reflex than traditional nerve stimulator. Its frequency of puncture is less and operational time is shorter than traditional nerve stimulator.