辣椒辣素预防前列腺术后不稳定膀胱的研究

目的探讨辣椒辣素预防良性前列腺增生(BPH)患者前列腺切除术后不稳定膀胱的作用。方法选择诊断为BPH,拟在硬膜外麻醉下行开放性前列腺切除术的病人40例,随机分为4组对照A组和膀胱灌注辣椒辣素组(B组),对照C组和硬膜外注入辣椒辣素组(D组),A、B两组分别在术前灌注生理盐水和含1mmol/L辣椒辣素的盐溶液100ml,30min后排空。C、D两组分别在硬膜外末次给药后30min注入生理盐水10ml(C组)、1mmol/L辣椒辣素10ml(D组),比较4组病人术前与术后的尿动力学指标变化的差异、膀胱痉挛的情况。结果辣椒辣素灌注组(B组)和硬膜外注入辣椒辣素组(D组)患者的膀胱稳定性明显增强,膀胱痉挛例数和持续时间、冲洗液转清时间、导尿管拔除时间均分别少于对照A、C组,疼痛程度明显减轻,各组相比有显著性差异(P<0.05)。从尿动力学检查结果来看,辣椒辣素灌注组(B组)和硬膜外注入辣椒辣素组(D组)患者的最大尿流率、膀胱容量、最大逼尿肌压力、残余尿量较术前的改变分别和对照组相比有很大不同。其中,膀胱容量和最大逼尿肌压力的改变较对照组差别显著(P<0.05)。结论膀胱灌注辣椒辣素和硬膜外注入低浓度辣椒辣素可以预防尿道梗阻引起的逼尿肌不稳定和膀胱痉挛,有效地预防前列腺切除术后出现的不稳定膀胱和膀胱痉挛性疼痛,改善膀胱的功能?

An experimental study of preventing unstable bladder after suprapubic prosta-tectomy during therapeutic of capsaicin

Objective To study and evaluate the effect of preventing unstable bladder after suprapubic prostatectomy during thera-py of Capsaicin in patients with BPH.Method Forty patients with BPH scheduled for suprapubic prostatectomy under epidural anesthesia were divided into four groups randomly (n=10,in each group):100ml of 1mmol/L capsaicin in saline was instilled into the bladder preoperatively for 30minutes in group B,group A received saline only.Group C received epidural injection of normal saline(NS)10ml and Group D had1mmol/L Capsaicin10ml were given epidurally.They were injected at30minutes after the final epidu-al infusion.It was observed to changes of preoperative and postoperative urodynamics,rate of cystospasm and the related complications.Results The unstable bladder was improved.The time of clear bladder perfusion and indwelling catheter delivery;postoperative cys-tospasm duration and case of postoperative cystospasm of group B and D reduced significantly compared respectively with group A and C.Conclusion Both preoperative therapeutic intravesical instillations of Capsaicin and epidural low concentration Capsaicin in-jection are believed to prevent both detrusor instability and cystospasm caused by urethra obstruction.It also improves postoperative function of patients’bladder by preventing postoperative unstable bladder and bladder spastic pain.