静脉应用维库溴铵预防膀胱侧壁肿瘤电切术闭孔神经反射的研究

目的探讨静脉应用维库溴铵在预防膀胱侧壁肿瘤行经尿道肿瘤电切术(TURBt)中发生闭孔神经反射的可行性。方法 统计哈尔滨医科大学附属肿瘤医院自2009年1月—2012年9月行经尿道膀胱肿瘤电切术的109例患者,其中采用静脉麻醉配合喉罩通气,同时应用肌松药物维库溴铵患者65例(静脉麻醉组),采用连续硬脊膜外麻醉者44例(连续硬膜外麻醉组),观察两组患者的一般情况、闭孔神经反射情况、膀胱穿孔、出血量情况、是否中转开放手术、以及术后留置导尿管时间情况。结果 静脉麻醉组与连续硬膜外麻醉组的一般情况差异无统计学意义。静脉麻醉组中,有5例于术中发生了极其轻微的下肢抖动,其余60例患者手术全程未发生闭孔神经反射;连续硬脊膜外麻醉组中,发生闭孔神经反射29例。与硬膜外组比较,静脉麻醉组中闭孔神经反射的发生率明显降低(P＜0.01)。结论 相对于连续硬膜外麻醉而言,全身麻醉同时静脉应用维库溴铵配合喉罩通气是一种简单、安全、有效的预防膀胱侧壁肿瘤电切术中发生闭孔神经反射的方法。

The research on intravenous injection of vecuronium in preventing obturator nerve reflex in the transure- thral resection of lateral wall bladder tumor

Objective To investigate the feasibility of method to prevent the obturator nerve reflex in the process of Transurethral Resection of Bladder Tumor（TURBt） of lateral wall bladder tumor. Methods A total of 109 patients suffered from lateral wall bladder tumor,who underwent TURBt from Jan 2009 to Sep 2012 ,were in- vestigated. Sixty - five patients were underwent intravenous anesthesia plus intravenous injection of muscle relax- ant drugs, vecuronium, the laryngeal mask airway ventilation was used at the same time. However, epidural anes- thesia was applied in 44 patients. Then, obturator nerve reflex, bladder perforation, bleeding, and indwelling cathe- ter time were investigated in these two groups, respectively. SPSS16.0 software was used for further statistical a- nalysis. P value less than 0.05 was considered to be statistically significant. Results There was no significant difference in the two groups about general situation. In intravenous anesthesia group, obturator nerve reflex oc- curred in 5 cases during operation, the other 60 patients didnt have obturator nerve reflex. In epidural anesthesia group,29 patients had obturator nerve reflex during operation. Compared with epidural anesthesia group, obturator nerve reflex rate was significantly reduced （ P 〈 0.01 ） in intravenous anesthesia group. Conclusion Compared with epidural anesthesia group,intravenous vecuronium plus the laryngeal mask airway ventilation is simple, safe, and effective method to prevent obturator nerve reflex in the TURBt of lateral wall bladder tumor.