硬膜外自控镇痛护理用于前列腺绿激光汽化术联合TURP术后膀胱痉挛的临床效果

摘要

Objective To investigate the nursing effect of patient-controlled epidural analgesia (PCEA) on the bladder spasm of severe benign prostatic hyperplasia (BPH) after photoselective vaporization of prostate (PVP) combined with transurethral resection of prostate (TURP). Methods Severe BPH patients (136 cases) undergoing PVP combined with TURP were enrolled in our study retrospectively, and all cases were divided into PCEA group (97 cases) and control group (39 cases). Patients in PCEA group were treated with PCEA pump, while those in control group received conventional antispasmodic measures. Chi-square test was performed to compare the incidence of postoperative bladder spasm and gross hematuria disappearance, indwelling catheter and hospitalization stay after surgery between the two groups. Results The incidence of postoperative bladder spasm symptom in PCEA group was 41.2%, which was significantly lower than that in control group (64.0%, P<0.01). Moreover, the ratio of gross hematuria disappearance at 24 h after surgery was 67.0% in PCEA group, which was obviously higher than that in control group (28.2%, P<0.01). In addition, more cases (84.5%) in PCEA group were removed catheter at 5 d after PVP than control group (61.5%), and the statistic difference reached significant level (P<0.05). However, there was no significant difference found for proportion of hospitalization stay less than 7 d between two groups (PCEA:91.8% vs control: 89.7%, P >0.05). Conclusion The PCEA pump plus comprehensive nursing treatment could improve the clinical postoperative outcomes for severe BPH patients underwent PVP combined with TURP.%目的:探讨硬膜外自控镇痛(PCEA)护理用于前列腺绿激光汽化术(PVP)联合经尿道前列腺电切术(TURP)治疗重度前列腺增生术后膀胱痉挛的效果研究.方法:回顾性分析136例重度前列腺增生接受PVP联合TURP手术病人的临床资料.其中97例术后留置PCEA泵者为观察组,39例常规对症解痉止痛治疗者为对照组,两组病人均接受综合性护理干预措施.比较并分析两组术后膀胱痉挛的发生率、尿液转清、尿管拔管时间及住院天数.结果:观察组膀胱痉挛发生率为41.2%,对照组为64.0%;观察组术后24 h尿转清为67.0%,对照组为28.2%;观察组术后5 d尿管拔管率为84.5%,对照组为61.5%,观察组均明显优于对照组(P<0.05).而术后住院天数小于7 d者观察组占91.8%,对照组占89.7%,两组比较无明显统计学差异(P>0.05).结论:PVP联合TURP治疗重度前列腺增生手术后应用PCEA泵辅助综合性护理干预手段,能够有效降低术后膀胱痉挛的发生率以及提升术后24 h尿转清和术后5 d尿管拔管的发生率,值得临床推广使用.