术中应用布托啡诺对导管相关膀胱刺激征的影响研究

The influence of using the Butorphanol to prevent the catheter-related bladder discomfort at post-operation

目的观测术中应用布托啡诺对术后导尿管相关膀胱刺激征(Catheter-related bladder discomfort,CRBD)的影响。方法选取60例ASAI～III全麻下行经尿道前列腺电切术(transurethral resection of the prostate,TURP)患者,随机分为对照组(n=30)和治疗组(n=30),治疗组在预计拔管前45分钟静脉注射布托啡诺注射液0.02mg/kg,对照组为等体积生理盐水,观测患者CRBD发生率与严重程度以及术后VAS评分。观察记录患者恶心呕吐、口干、嗜睡等不良反应发生率。手术前1天及术后24小时进行2分钟步行测验(2MWT)。结果各个时间点治疗组出现CRBD发生率和程度均低于对照组(P值<0.05),与对照组相比,治疗组组VAS评分与芬太尼用量均减少(P值<0.05)。术后24小时2分钟步行距离,布托啡诺组长于对照组(P值<0.05),术后恶心呕吐、缺氧发生率比较,治疗组与对照组差异无显著性(P值>0.05),治疗组发生低氧血症4例,对照组1例,P值<0.05,但经对症处理后无明显并发症,不影响布托啡诺的治疗疗效。结论术中给予布托啡诺可有效预防和降低导管相关膀胱刺激征,促进术后恢复,且无严重不良反应。

Objective To evaluated the effect of butorphanol using in the operation for preventing catheter-related bladder discomfort（CRBD） at post-operation.Methods Sixty adults （55 - 80 yr）, ASA Ⅰ -Ⅲ underwent transnrethral resection of the prostate （TURP） were randomly divided into two groups： Control group（group C）, they received normal saline（NS： 2ml）, whereas the butorphanol group（group B） received butorphanol 0.02 mg/kg.All medications were diluted in 2ml NS and administered for 45 mins before extuhation.The CRBD was assessed at 0, 1^st , 2^nd ,and 6th hour after patient＇s arrival in the post-anesthesia care unit along with the ward.Severity of CRBD was graded as none, mild, moderate and severe.Postoperative pain was assessed by VAS.Side effects such as vomit, nausea, dry mouth and dizziness were recorded. 2 minutes walking tests （2MWT） was assessed 1 day before surgery and 24h after operation.Results Incidence and severity of CRBD were reduced in the group B compared with the group C at all time points（P 〈0.05）.Postoperative pain was also reduced in the group B compared with the group C（P〈0.05）.There was a significant increased 2MWT distance on one day postoperative compared to controlled group（ P〈0.05 ）. Conclusions Butorphanol with 0.2 mg/kg administered for iv at 45 min before extubation can reduce the incidence and and severity of CRBD, promote the functional walking capacity recovery and there are not several severe complications.