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目的观察并比较经耻骨上前列腺切除术(SPP)后舒芬太尼复合罗哌卡因硬膜外镇痛(PCEA)与舒芬太尼静脉镇痛(PCIA)的临床效果。方法选择SPP患者30例,ASAⅡ或Ⅲ级,随机分为二组(n=15),PCEA组(RS)和PCIA(S)组,选择L2-3间隙穿刺,记录术后第6h、24h、48h(T6、T24、T48)运动神经阻滞程度,记录术后即刻～6h(t1)、术后6～24h(t2)、术后24～48h(t3)时段膀胱痉挛次数,采用视觉模拟评分法(VAS)记录病人膀胱痉挛时和非痉挛时的疼痛程度;记录相关副作用及术后48h膀胱冲洗液内红细胞的总数。结果RS组T6时点Bromage评分明显高于S组(P<0.05),但T24、T48时点二组间差异无统计学意义。术后t1时段二组膀胱痉挛次数差异无统计学意义;但t2、t3时段RS组少于S组(P<0.05)。RS组膀胱痉挛时VAS评分明显低于S组(P<0.05),而在非膀胱痉挛时二组之间差异无统计学意义。RS组术后48h膀胱冲洗液内红细胞总数低于S组(P<0.05)。结论与舒芬太尼PCIA相比,SPP后使用0.15%罗哌卡因混合舒芬太尼进行PCEA能更有效地减少SPP后膀胱痉挛,减少前列腺窝创面的出血量。
Objective To observe and compare the clinical effects of sufentanil combined with ropivacaine epidural analgesia (PCEA) and sufentanil intravenous analgesia (PCIA) after suprapubic prostatectomy (SPP). Methods Thirty ASA Ⅱ or Ⅲ patients with SPP were randomly divided into two groups (n = 15), PCEA group (PCIA group) and PCIA (S) group. L2-3 interstitial puncture was selected and recorded at 6h, 24h, 48h (T6, T24, T48) motor nerve block were recorded. The number of bladder spasm at 6h (t1), 6-24h (t2) and 24-48h (t3) Method (VAS) recorded the degree of pain in patients with cystospasm and non-spasm; recorded the side effects and the total number of red blood cells in the bladder irrigating solution 48h after operation. Results The Bromage score at T6 was significantly higher in RS group than in S group (P <0.05), but there was no significant difference between the two groups at T24 and T48. There was no significant difference in the number of bladder spasm between the two groups at t1, but less in RS group at t2 and t3 (P <0.05). The VAS score of RS group was significantly lower than that of S group (P <0.05), but there was no significant difference between the two groups in non-bladder spasm. The total number of erythrocytes in bladder irrigating solution 48 h after operation in RS group was lower than that in S group (P <0.05). Conclusion Compared with sufentanil PCIA, PCEA combined with sufentanil 0.15% ropivacaine after SPP can effectively reduce bladder spasm after SPP and reduce the bleeding volume of prostate fossa wounds.