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目的 :探讨经尿道前列腺汽化电切术 (TUVP)后膀胱痉挛性疼痛防治方法。方法 :TUVP患者 60例 ,术后病人按不同的解痉镇痛方法随机分成三组 ,Ⅰ组 (对照组 ) ,当膀胱痉挛疼痛时肌注哌替啶 1mg/kg ,阿托品 0 0 1mg/kg;Ⅱ组术后保留硬膜外导管 ,间隔硬膜外腔注药镇痛 ,Ⅲ组术后行硬膜外自控镇痛 (PCEA) ,所有病人治疗时间为 3d ,术后以疼痛视觉模拟评分法 (VAS)间接评估镇痛效果 ,定时记录膀胱内压、膀胱痉挛次数及病人术后恢复情况。结果 :术后膀胱痉挛性疼痛发生率Ⅲ组、Ⅱ组、Ⅰ组分别为 2 0 %、4 5 %、75 % (P<0 0 5 ) ;术后 3 6h三组病人膀胱痉挛性疼痛发生次数为Ⅲ组 <Ⅱ组 <Ⅰ组 (P <0 0 5 ) ,术后镇痛效果Ⅲ组 >Ⅱ组 >Ⅰ组 (P <0 0 5 ) ;Ⅰ组病人术后 3d膀胱内压明显高于Ⅱ组和Ⅲ组病人 ,术后 2dⅡ组明显高于Ⅲ组 (P<0 0 5 ) ;Ⅱ组和Ⅲ组病人术后尿液转清、拔尿管时间均明显早于Ⅰ组 (P <0 0 5 ) ,Ⅰ组有 2例病人因术后出血再手术。结论 :TUVP后膀胱痉挛性疼痛临床防治方法中 ,硬膜外注药的效果明显优于传统的肌注用药 ,应用PCEA模式效果更佳。
Objective: To investigate the prevention and treatment of bladder spasm pain after transurethral vaporization of the prostate (TUVP). Methods: Sixty patients with TUVP were randomly divided into three groups according to different methods of spasticity and analgesia: group Ⅰ (control group), pethidine 1 mg / kg and atropine 0 0 1 mg / kg ; Group Ⅱ, epidural catheter was reserved after operation, epidural analgesia was given to epidural space, epidural analgesia (PCEA) was performed in group Ⅲ after operation, all patients were treated for 3d, postoperative pain visual analogue scale Method (VAS) indirect assessment of analgesic effect, regular record of bladder pressure, bladder spasm and the number of patients with postoperative recovery. Results: The incidence of postoperative bladder spasm pain was 20%, 45% and 75% respectively in group Ⅲ, group Ⅱ and group Ⅰ (P <0 05). The bladder spasm pain occurred in all three groups at 36 hours after operation The number of group Ⅲ was significantly higher than that of group Ⅱ (P <0.05), group Ⅲ was better than group Ⅱ> group Ⅰ (P0.05) In group Ⅱ and group Ⅲ, the level of urine in group Ⅱ and group Ⅲ after operation was significantly higher than that of group Ⅲ (P <0 05) <0 0 5). There were 2 patients in group Ⅰ who underwent reoperation due to postoperative bleeding. Conclusion: In the clinical methods of prevention and treatment of bladder spasm pain after TUVP, the effect of epidural injection is obviously better than that of traditional intramuscular injection, and PCEA mode is more effective.