硬膜外自控泵预防膀胱肿瘤和前列腺增生术后膀胱痉挛的失败原因及处理对策

摘要

Objective To investigate the failure causes of bladder spasm after bladder cancer and prostate operation with epidural self-controlled analgesia pump and ifnd countermeasures.Methods From March 2010 to March 2016, 302 patients were adopted PCEA after transurethral resection of bladder tumor and prostate to prevent bladder spasm while failed in 18 cases and occurred bladder spasm. Among the 18 cases, 2 cases because of power loss of the pump, 3 cases occurred slippage of epidural catheter, 2 cases suffered catheter obstruction, 2 cases suffered joint leakage, 3 cases of deifciency of anesthetic dose formula, 2 cases of incomplete analgesia, 4 cases of chemotherapy drug stimulation. All the patients were relieved from countermeasures.Results In the 18 patients, the countermeasures were effective and satisfactory, with no serious complications such as severe hematuria, urinary tract infection and ifstula infection occurred.Conclusions PCEA prevent postoperative bladder spasm with deifnite effect. If the postoperative analgesia effect is poor, then we should analyze the reasons timely and ifnd countermeasures to avoid serious complications.%目的：探讨硬膜外自控镇痛泵防治膀胱肿瘤和前列腺术后膀胱痉挛的失败原因和处理对策。方法2010年3月-2016年3月在经尿道膀胱肿瘤和前列腺切除术后，采取硬膜外自控泵镇痛（PCEA）预防膀胱痉挛302例，镇痛失败而发生膀胱痉挛18例。其中，2例自控泵电源不足，3例硬膜外导管滑脱，2例导管阻塞，2例接头漏液，3例麻药配方剂量不足，2例镇痛不全，4例化疗药物刺激。分别采取相应处理措施。结果18例患者，防治效果满意，未出现严重血尿、术后尿道和造瘘口感染等严重并发症。结论 PCEA防治膀胱肿瘤前列腺术后膀胱痉挛效果肯定，若术后镇痛效果不佳，要及时分析原因，并积极采取相应处理措施，以免引起严重并发症。