硬膜外麻醉复合膀胱穿刺局部麻醉对膀胱侧壁肿瘤电切术患者闭孔神经反射的影响

目的 探讨硬膜外麻醉复合膀胱穿刺局部麻醉对膀胱侧壁肿瘤电切术患者闭孔神经反射的影响.方法 回顾性分析92例膀胱侧壁肿瘤患者的临床资料,根据手术麻醉方式的不同将患者分为观察组和对照组,每组46例,观察组患者行硬膜外麻醉复合膀胱穿刺局部麻醉,对照组患者行硬膜外麻醉复合闭孔神经分支后两点阻滞.比较两组患者闭孔神经反射和并发症的发生情况.结果 观察组患者闭孔神经反射的发生率为6.5%(3/46),低于对照组的21.7%(10/46),差异有统计学意义(P﹤0.05);观察组和对照组患者膀胱穿孔、血肿、血管损伤、肠道损伤的发生率比较,差异无统计学意义(P﹥0.05).结论 硬膜外麻醉复合膀胱穿刺局部麻醉可以降低膀胱侧壁肿瘤患者闭孔神经反射的发生率,是一种安全有效的治疗方式.

Effect of epidural anesthesia combined with local anesthesia by bladder puncture on the obturator nerve reflex in patients with tumor at bladder lateral wall treated with transurethral bladder tumor resection

Objective To explore the effect of epidural anesthesia combined with local anesthesia by bladder punc-ture on the obturator nerve reflex in patients with tumor at bladder lateral wall that were treated with transurethral resec-tion of bladder tumor(TURBT).Method 92 cases of patients with tumor at bladder lateral wall were included in the ret-rospective analysis,and were stratified as study group or control group according to the way of anesthesia,each group in-cluded 46 cases,and patients in study group were administered with epidural anesthesia combined with local anesthesia by bladder puncture,while control group was given epidural anesthesia combined with obturator nerve block.The inci-dence of obturator nerve reflex and complications of the two groups were compared.Result The incidence of obturator nerve reflex in study group was 6.5%(3/46),which was lower than that in control group at 21.7%(10/46),and the differ-ence was of statistically significance(P<0.05);the two groups were similar in regard of the incidence of bladder perfora-tion,hematoma,vascular injury and intestinal injury,with no significant difference observed(P>0.05).Conclusion Epi-dural anesthesia combined with local anesthesia by bladder puncture can significantly reduce the incidence of obturator nerve reflex in patients with tumor at bladder lateral wall,and it is a safe and effective treatment.