摘要
目的 评价经尿道膀胱肿瘤电切术患者腹股沟上入路闭孔神经阻滞定位的效果：与耻骨入路比较.方法 择期经尿道膀胱肿瘤电切术患者60例,性别不限,年龄41 ～ 80岁,体重指数17.5 ～ 31.0 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为2组（n=30）：耻骨入路组（P组）和腹股沟上入路组（S组）.在神经刺激仪引导下采用电刺激穿刺针进行闭孔神经阻滞.P组穿刺点为耻骨结节外1.5 cm下1.5 cm.S组穿刺点为腹股沟皱褶除长收肌缘与股动脉连线中点,沿大腿长轴向头侧3 cm.记录首次诱发内收肌收缩的穿刺次数、穿刺开始至诱发内收肌收缩的时间间隔、穿刺深度和穿刺过程中最高VAS评分.评估大腿内收肌肌力.记录并发症的发生情况.结果 与P组比较,S组穿刺次数减少,时间间隔缩短,穿刺深度和最高VAS评分降低,一次穿刺成功率升高,阻滞4和6 min时大腿内收肌肌力降低（P＜0.05或0.01）.2组穿刺部位出血发生率比较差异无统计学意义（P＞0.05）.结论 与耻骨入路比较,经尿道膀胱肿瘤电切术患者腹股沟上入路闭孔神经阻滞定位准确,起效快,伤害性刺激程度轻,安全性好.
Objective To compare the efficacy of suprainguinal approach and pubic tubercle approach to obturator nerve block （ONB） in patients undergoing transurethral resection of bladder tumor.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-80 yr,with body mass index of 17.5-31.0 kg/m2,scheduled for elective transurethral resection of bladder tumor,were randomly divided into 2 groups （n =30 each） using a random number table：pubic tubercle approach group （group P） and suprainguinal approach group （group S）.Nerve blocks were performed using a 100-mm insulated needle for ONB （21-gauge） under the guidance of a nerve stimulator.In group P,the insertion point of the needle was 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle.In S group,the insertion point of the needle was at the midpoint of the line drawn in the inguinal crease between the femoral artery and the inner border of the adductor longus tendon and the needle was advanced 3 cm cephalad in the major axis of thigh.The number of puncture eliciting contraction of adductor muscle,time taken to elicit contraction of adductor muscle starting from onset of puncture,depth of puncture,and highest visual analog scale （VAS） pain scores during application of the block were recorded.The myodynamia of adductor muscle was evaluated.The development of complications was also recorded.Results Compared with group P,the number of puncture,highest VAS scores,and myodynamia of adductor muscle at 4 and 6 min of blockade were significantly decreased,the time taken to elicit contraction of adductor muscle was shortened,and the success rate of puncture at first attempt was increased in group S （P 〈 0.05 or 0.01）.There was no significant difference in the incidence of puncture point bleedings between the two groups （P 〉 0.05）.Conclusion The suprainguinal approach for ONB offers more accurate location,faster onset,lighter degree of noxious stimulation and better safety than the pubic tubercle approach in patients undergoing
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第12期1454-1457,共4页
Chinese Journal of Anesthesiology
