镇痛时间对经尿道前列腺电切术术后的影响

目的：通过对经尿道前列腺电切术（transurethral resection of prostate,TURP）术后硬膜外镇痛（patient-conty-olled epidural analgesia,PCEA）期间和术后过程的随访,研究PCEA时间与术后膀胱出血量的关系,以改善PCEA的质量。方法：择期经尿道前列腺电切术患者46例,其中3例不符合纳入标准被剔除。ASAⅠ～Ⅱ级,年龄（64.5±7.6）岁。L2-3腰-硬联合麻醉,术毕PCEA为5ml/h,配方为：0.125%罗哌卡因-舒芬太尼0.1ug/ml-托烷司琼5mg加0.9%氯化钠溶液稀释至250ml。全部患者按PCEA时间分成两组,A组（n=20）：PCEA时间为50h;B组（n=23）：PCEA时间为100h。研究视觉模拟评分（VAS）、膀胱冲洗量、持续冲洗时间和住院时间。结果：两组患者的一般情况、术中出血量差异无统计学意义（P〉0.05）。膀胱持续冲洗期间,B组在术后第3天起的冲洗量比A组大幅减少,均值分别为2.7、4.1（P〈0.01）,两组患者至术后第4天盐水用量分别为1.5、2.8（P〈0.01）。B组持续冲洗时间为（121.1±30.2）h较A组的（145.3±42.1）h有所缩短（P〈0.05）。但两组住院时间分别为（9.7±1.6）d和（9.1±1.4）d（P〉0.05）差异无统计学意义。PCEA期间第3天开始A组的VAS有一定程度反弹,而B组镇痛良好,显示不同时间的镇痛存在差异（P〈0.01）。结论：与常规50h镇痛相比,镇痛时间延长至96h以上,更能显著减少冲洗后期出血量,缩短膀胱冲洗时间,有助于加快术后恢复,提高恢复质量和患者对PCEA的满意程度。

The impact of postoperative analgesia time on transurethral resection of prostate

Objective：By transurethral resection and postoperative epidural analgesia during the course of follow-up study PCEA time and the relationship between the amount of bleeding bladder to improve the quality of PCEA.Methods：Elective transurethral resection of 46 patients,ASA Ⅰ-Ⅱ grade,the age was（64.5±7.6） years.L2-3 spinal-epidural anesthesia,of surgery PCEA was 5 ml/h,formula：0.125% ropivacaine-sufentanil 0.1 ug/ml-tropisetron 5 mg plus 0.9% sodium chlo ride solution diluted to 250 ml.All patients were divided into two groups according to PCEA time,A group（n=20）：PCEA time was 50 hours;B group（n=23）：PCEA time was 100 hours.Of visual analogue scale（VAS）,bladder irrigation volume,con tinue washing and hospital stay.Results：Two groups in general,small differences in blood loss,no statistical significance（P〉0.05）.Continuous bladder irrigation period,B group from the 3rd day after the washing significantly reduced compared to A group,the average values were 2.7,4.1（P〈0.01）,two groups of patients to 4 days after saline consumption were 1.5,2.8（P〈0.01）.Group B continued washing time（121.1 ± 30.2） hours compared with A group（145.3±42.1） hours has reduced（P〈0.05）.But the two groups of hospital stay was（9.7±1.6） days and（9.1±1.4） days（P〉0.05） no significant difference.During the 3th day PCEA group VAS A rebound to some extent,while B group without pain,show differences at different times of analgesia（P〈0.01）.Conclusion：Compared with the conventional 50 hours pain,analgesia extended for more than 96 hours,more significantly reduce the amount of bleeding post-washing,reduced bladder washout time,helps speed up recov ery after surgery,improve the quality of recovery and the patient＇s PCA satisfaction.