前列腺增生症术后膀胱痉挛的原因分析及处理

目的 :探讨造成前列腺增生术后膀胱痉挛 (Bladderspasm :BS)的原因 ,并观察硬膜外自控镇痛法 (Patient-controlledepidu ralanalgesia ,PCEA)对BPH术后膀胱痉挛的影响。方法 :对前列腺术后 94例发生膀胱痉挛的患者行术前尿动力学分析 ,并结合患者及术式的特点行术前、术中、术后的原因分析。随机选择 90例BPH患者行PCEA、PCIA(Patient-controlledintravenousanal gesia)和CAT(Conventionalanalgesiatherapy)治疗 (各 30例 )并作对照。结果 :术前有不稳定膀胱、低顺应性膀胱、逼尿肌反射亢进者 ,术后易发生膀胱痉挛 ,HIFU(Highintensityfocusedultrasound)比较TURP术 ,BS的发生率较低。PCEA治疗组的BS明显减少(P <0 .0 5 ) ,发作时间也明显缩短 (P <0 .0 0 1)。罗呱卡因与曲马多配伍应用 ,不良反应少 ,疗效强。结论 :BPH患者术前尿动力学检查对防治BS有重要意义。PCEA能明显降低膀胱痉挛的频度和强度

Analysis and Management in the Cause of Cystospasm after Prostatic Hypertrophy Operation

Objective: To discuss the cause of cystospasm after prostatic hypertrophy operation,To observe the effect of patient-controlled epidural analgesia(PCEA) on bladder spasm after prostatic hypertrophy operation.Methods: 94 prostatic hyperplasia cases with cystospasm were studied with preoperative urine dynamics examination,Analysis the cause of preoperative and operating and postoperative characterization of patients and operative way.To compare the effectiveness of PCEA group (n 1=30) with patient-controlled intravenous analgesia(PCIA)(n 2=30) and conventional analgesia therapy(CAT)(n 3=30).Results: Unstable bladder and low compliance bladder and detrusor overactivity preoperatively are subject to cystospasm postoperatively.The incidence of cystospasm in HIFU group were less than those of TURP group (P<0.001).The frequency and the duration of postoperative cystospasm in PCEA group were less and shorter than those of PCIA and CAT group(P<0.05).Ropivacaine and tramadol conduct a combined use was characterized by effeciacy and less side effect.Conclusion:Prostatic hyperplasia cases were studied with preoperative urine dynamics examination are of important significance in defend and treat bladder spasm.PCEA is believed to decrease the frequency and intensity of bladder spasm.