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目的探讨我院经尿道膀胱肿瘤电切术中,应用闭孔神经反射预防方法的经验体会。方法回顾性总结分析我院自2004年以来的3年中在经尿道膀胱肿瘤电切术中,应用闭孔神经反射预防方法的临床资料。经尿道膀胱肿瘤电切术的患者186例,分成三组,其中第一组应用硬膜外麻醉和肌松药及面罩给氧122例,第二组应用全身麻醉42例,第三组应用硬膜外麻醉和闭孔神经阻滞麻醉22例。结果第一组有10例出现轻微的闭孔神经反射,未造成膀胱穿孔,有5例出现严重的闭孔神经反射,造成轻微的膀胱穿孔4例,不需要膀胱修补,造成1例严重的膀胱穿孔、大出血,需要行膀胱修补术。第二组和第三组出现2例轻微的闭孔神经反射。结论硬膜外麻醉是不可能抑制闭孔神经反射的,肌松药的应用可以抑制膀胱肌肉的收缩,实际上这种方法对小的膀胱肿瘤,手术时间短是非常有效的。但对大的膀胱肿瘤,手术时间长是不合适的。对大的膀胱肿瘤或多发的膀胱肿瘤,应用全身麻醉是非常合适的。上述两种方法应用中掌握肌松药的应用量和维持时间是非常重要的,电切中出现膀胱穿孔多是由于肌松药的应用量或维持时间不够造成闭孔神经反射所致。闭孔神经阻滞麻醉的联合应用是最经济的方法。
Objective To explore the experience of using obturator nerve reflex in transurethral resection of bladder tumor in our hospital. Methods The retrospective analysis of clinical data of obstructive nerve reflex in the treatment of transurethral resection of bladder tumor in our hospital for three years since 2004 was retrospectively analyzed. Transurethral resection of the bladder tumor in 186 patients were divided into three groups, of which the first group of epidural anesthesia and muscle relaxants and mask oxygen in 122 cases, the second group of 42 cases of general anesthesia, the third group of hard Extramedullary anesthesia and obturator nerve block anesthesia in 22 cases. Results In the first group, there were 10 cases with slight obturator nerve reflex, no bladder perforation, 5 cases with obstructive obturator reflex, 4 cases with slight bladder perforation, no bladder repair and 1 case with severe bladder Perforation, bleeding, the need for bladder repair. There were 2 mild obturator reflexes in the second and third groups. Conclusion Epidural anesthesia can not inhibit obturator nerve reflex. The application of muscle relaxant can inhibit bladder muscle contraction. In fact, this method is very effective for small bladder tumors and short operative time. But for large bladder tumors, surgery is not suitable for a long time. For large bladder tumors or multiple bladder tumors, the application of general anesthesia is very suitable. The application of these two methods to control the amount of muscle relaxants and maintenance of time is very important, the electrovaporation of the bladder perforation are mostly due to the amount of muscle relaxants or maintain time caused by obturator nerve reflex. Closed-circuit nerve block anesthesia combined application is the most economical method.