胸椎旁神经阻滞与尿道黏膜麻醉联合用于尿道置管对患者尿道及膀胱刺激的影响

doi:10.3969/j.issn.1671-7171.2020.02.028

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摘要 【目的】探讨超声引导下胸椎旁神经阻滞麻醉(PVB)联合尿道黏膜麻醉在肾结石手术经尿道置管患者中的应用价值。【方法】140例肾结石患者,用随机分为A组和B组,各70例,两组患者均采用经皮肾镜碎石术,A组采用超声引导下PVB联合尿道黏膜麻醉,B组采用超声引导下PVB;比较两组患者麻醉前(T₀)、麻醉后10 min(T₁)、建立碎石通道后(T₂)、碎石术中(T₃)、术毕(T₄)患者的心率(HR)、平均动脉压(MAP);比较两组患者术中经尿道置管时膀胱刺激征程度、术后血尿及各种不良反应发生率。【结果】T₀、T₃、T₄时刻,A组和B组的HR相比较差异无显著性(P>0.05);在T₁、T₂时刻,A组的HR值分别高于和低于B组(P<0.05);T₀、T₄时刻,A组和B组的MAP相比较差异无显著性(P>0.05);在T₁、T₂、T₃时刻,A组的MAP值均高于B组(P<0.05);A组患者术中尿道置管过程中膀胱刺激征的发生程度低于B组患者(P<0.05);A组患者术后血尿发生率为31.43%(22/70),低于B组的47.14%(33/70)(P<0.05);A组患者不良反应发生率低于B组,且差异具有显著性(P<0.05)。【结论】超声引导下PVB联合尿道黏膜麻醉在肾结石手术经尿道置管患者中的应用有利于减轻对患者尿道及膀胱的刺激作用、维持患者术中血流动学的稳定、减少术后各种不良反应的发生。

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	郝晓燕

关键词 ：导管,留置, 尿道, 黏膜, 神经传导阻滞/方法, 麻醉

Abstract：【Objective】To explore the value of ultrasound-guided thoracic paravertebral nerve block anesthesia (PVB) combined with urethral mucosal anesthesia in patients with renal calculi undergoing transurethral catheterization.【Methods】A total of 140 patients with kidney stones were randomly divided into group A and group B with 70 cases in each group. Patients in both groups received percutaneous nerve lithotripsy. Group A used ultrasound-guided PVB combined with urethral mucosal anesthesia, while group B used ultrasound-guided PVB only. The heart rate (HR) and mean arterial pressure (MAP) were compared between the two groups of patients before anesthesia (T₀), 10 minutes after anesthesia (T₁), after the establishment of a lithotripsy (T₂), during lithotripsy (T₃) and end of surgery (T₄). Meanwhile, the degree of bladder irritation, postoperative hematuria and the incidence of various adverse reactions were recorded and compared during the intraoperative urethral catheterization. 【Results】At T₀, T₃ and T₄, the HR values were not statistically significant difference between group A and group B (P>0.05). At T₁ and T₂, the HR values of group A were higher than those of group B (P<0.05). At T₀ and T₄, the difference of MAP between group A and group B was not statistically significant (P>0.05). At the time of T₁, T₂ and T₃, the MAP value of group A was higher than that of group B (P<0.05). The incidence of bladder irritation during urethral catheterization in group A was lower in group than that in group B (P<0.05). The incidence of postoperative hematuria in group A was 31.43%, which was lower than that in group B (47.14%); the difference was statistically significant (P<0.05). The incidence of adverse reactions in group A was lower than that in group B (P<0.05).【Conclusion】Ultrasound-guided PVB combined with urethral mucosal anesthesia in patients with renal calculi undergoing transurethral catheterization is beneficial to reduce the irritating effect on the urethra and bladder of patients, maintain the stability of blood flow during surgery, and reduce various adverse reactions after operation.

Key words： Catheters,Indwelling Urethra Mucous membrane Nerve Block/ME Anesthesia

收稿日期: 2018-07-19

PACS:

R61

引用本文:

郝晓燕. 胸椎旁神经阻滞与尿道黏膜麻醉联合用于尿道置管对患者尿道及膀胱刺激的影响[J]. 医学临床研究, 2020, 37(2): 252-254.
HAO Xiao-yan. Effect of Thoracic Paravertebral Nerve Block Combined with Urethral Mucosal Anesthesia on Urethral and Bladder Irritation in Patients with Urethral Catheterization. JOURNAL OF CLINICAL RESEARCH, 2020, 37(2): 252-254.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2020.02.028 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2020/V37/I2/252