[1]刘军 冯雅薇 李响 罗刚健.预防经尿道膀胱肿瘤电切术中闭孔神经反射的麻醉方法比较[J].中华腔镜泌尿外科杂志(电子版),2015,(05):360-362.[doi:10.3877/cma.j.issn.1674-3253.2015.05.013 ]
　Liu Jun,Feng Yawei,Li Xiang,et al.Comparative study on anesthesia methods of preventing obturator nerve reflection during transurethral resection of the bladder tumor[J].,2015,(05):360-362.[doi:10.3877/cma.j.issn.1674-3253.2015.05.013 ]
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预防经尿道膀胱肿瘤电切术中闭孔神经反射的麻醉方法比较()
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中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2015年05期
页码:
360-362
栏目:
临床研究
出版日期:
2015-12-31

文章信息/Info

Title:
Comparative study on anesthesia methods of preventing obturator nerve reflection during transurethral resection of the bladder tumor
作者:
刘军 冯雅薇 李响 罗刚健
510630 广州，中山大学附属第三医院麻醉科
Author(s):
Liu Jun;  Feng Yawei;  Li Xiang;  Luo Gangjian.
Department of Anesthesis, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
关键词:
膀胱肿瘤; 经尿道肿瘤切除术; 闭孔神经反射; 麻醉
DOI:
10.3877/cma.j.issn.1674-3253.2015.05.013
摘要:
目的探讨比较在经尿道膀胱肿瘤电切术（ TURBt）中三种不同的麻醉方式对于预防闭孔神经反射的效果，从而选择最佳的麻醉方式。方法回顾性分析中山大学附属第三医院 2014年 1月至 2015年 4月间收治的 ASAⅠ～II级经膀胱镜检查诊断为侧壁或多发表浅性膀胱肿瘤，行 TURBt的患者。根据麻醉方式的不同，将其分为三组：椎管内麻醉组（ A组）、全麻组（ B组）和椎管内麻醉联合闭孔神经阻滞麻醉组（ C组），每组 30例。比较 3组患者术前、术中和手术结束时平均动脉压（ MAP）、心率（ HR）的变化以及手术时间，统计闭孔神经反射次数，是否引起严重的并发症（膀胱穿孔，大出血等）。结果三组患者一般情况和术前、术中、术后的生命体征比较差异均无统计学意义（ P>0.05）。在预防闭孔神经反射发生概率方面， A组与 B、C组相比，差异具有统计学意义（ P<0.05）。B组与 C组相比差异无统计学意义（ P>0.05）。结论椎管内麻醉复合闭孔神经阻滞与全身麻醉均可以较好地抑制经尿道膀胱肿瘤电切术中闭孔神经反射发生。

参考文献/References:

[1] Cesur M, Erdem AF, Alici HA, et al. The role of succinylcholine in the prevention of the obturator nerve reflex during transurethral resection of bladder tumors [J]. Saudi Med J, 2008, 29 (5): 668-671.
[2] Soong J, Schafhalter-Zoppoth I, Gray AT.. Sonographic imaging of the obturator nerve for regional block[J]. Reg Anesth Pain Med, 2007, 32 (2): 146-151.
[3] 姜博,朱强,张海峰.经尿道膀胱肿瘤电切术中预防闭孔神经反射致膀胱穿孔的不同方法介绍[J/CD].中华腔镜泌尿外科杂志, 2011, 5(2): 126-128.
[4] Shankar H. Ultrasound-guided steroid injection for obturator neuralgia[J]. Pain Practice, 2008, 8(4): 320-323.
[5] Akkaya T, Comert A, Kendir S, et al. Detailed anatomy of accessory obturator nerve blockade [J]. Minerva Anestesiol, 2008, 74:119-122.
[6] 李爱军 ,张科 ,贾全安 ,等.耻骨上经膀胱闭孔神经阻滞法在经尿道膀胱肿瘤电切术中的应用[J].临床泌尿外科杂志 , 2014,请补充卷(11): 32-34.
[7] 张本福.新径路闭孔神经阻滞在经尿道膀胱肿瘤电切术中的应用[J].临床麻醉学杂志, 2011, 27(4): 388-389.
[8] Mikelsaar AV1, Sünter A, Mikelsaar R, et al. Epitope of titin A-band-specific monoclonal antibody Tit1 5 H1.1 is highly conserved in several Fn3 domains of the titin molecule. Centriole staining in human, mouse and zebrafish cells[J]. Cell Div, 2012, 7 (1), 21.
[9] Viel EJ, Perennou D, Ripart J, et al. Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles [J]. Eur J Pain, 2002, 6(2): 97.
[10] So PC. Two case reports of obturator nerve block for transurethral resection of bladder tumor [J]. Hong kong Med J, 2004, 10 (1): 57-59.
[11] 张康为 .腹腔镜与传统开腹手术治疗老年直肠癌的疗效［ J］．中国老年学杂志, 2013, 33(22): 5593-5594.
[12] Khorrami MH, Javid A, Saryazdi H, et al. Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral bladder surgery [J]. J Endourol, 2010, 24 (10): 1651-1654.

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备注/Memo

备注/Memo:
基金项目：广东省科技计划项目（2014A020212707）
通讯作者：罗刚健，Email:18922102871@163.com
更新日期/Last Update: 1900-01-01