关键词: 膀胱肿瘤, 经尿道膀胱肿瘤电切术, 闭孔神经阻滞, 瑞马唑仑, 闭孔神经反射

Abstract: Objective To observe the effects of ultrasound-guided modified obturator nerve block (ONB) combined with remazolam anesthesia on obturator nerve reflex (ONR) and postoperative recovery of patients with transurethral resection of bladder tumors (TURBT). Methods One hundred patients with bladder tumor admitted to Qinhuangdao Hospital from June 2019 to June 2021 were treated with TURBT. They were divided into conventional group (intraspinal anesthesia + traditional ONB anesthesia) and ultrasound group (intraspinal anesthesia + improved ONB combined with remidazolam anesthesia under ultrasound guidance) with 50 cases in each according to different ONB methods. Perioperative indexes, hemodynamic indexes at different time points, intraoperative ONR occurrence, complications and adverse anesthesia reactions were compared between the two groups. Results Compared with conventional group, ONB time, operation time, catheter indwelling time and hospital stay were shortened, and intraoperative blood loss was decreased in ultrasound group (P＜0.05). Compared with the conventional group at 30 min after administration (T1) and at the end of operation (T2), the mean arterial pressure (MAP) and oxygen saturation (SaO₂) were increased in the ultrasound group (P＜0.05). Compared with the conventional group, the incidence of ONR and bladder bleeding was decreased, and the incidence of postoperative bradycardia, nausea and vomiting were decreased in the ultrasound group (P＜0.05). Conclusions Ultrasound-guided modified ONB combined with remazolam anesthesia can effectively improve perioperative indexes of TURBT, reduce intraoperative ONR and bladder bleeding, and have little influence on hemodynamics with few postoperative adverse anesthesia reactions.

Key words: bladder tumor, transurethral bladder tumor resection, obturator nerve block, remazolam, obturator nerve reflex