右美托咪定预防麻醉恢复期导尿管相关膀胱刺激征的效果

Efficacy of dexmedetomidine application in preventing catheter-related bladder discomfort during recovery

目的观察右美托咪定不同时机给药预防麻醉恢复期导尿管相关膀胱刺激征(CRBD)的有效性和安全性。方法择期全身麻醉下拟行脊柱手术的男性患者60例,随机分为A、B及C组,每组20例。A组与B组分别在全身麻醉诱导前15min、手术结束前30min静脉泵注右美托咪定0.5μg/kg;C组为对照组,静脉泵注等容量生理盐水。3组患者气管插管后留置导尿管,记录3组手术时间、自主呼吸恢复时间、苏醒时间、拔管时间,以及拔管后5min(T1)、30min(T2)、1h(T3)的CRBD分级及Ramsay镇静评分。结果A组与C组T1~T3时CRBD严重程度比较,差异无统计学意义(P>0.05);B组T1~T3时CRBD严重程度降低(P<0.05)。与A组比较,B组T2、T3时CRBD严重程度降低(P<0.05)。B组T1~T3时Ramsay镇静评分较A、C组高(P<0.05);3组其余指标比较,差异无统计学意义(P>0.05)。结论手术结束前30min应用右美托咪定预防麻醉恢复期导尿管相关膀胱刺激征效果好,且不影响麻醉恢复。

Objective To observe the efficacy and safety of dexmedetomidine application at different time in preventing catheter-related bladder discomfort (CRBD) during recovery from anesthesia in patients undergoing general anesthesia. Methods Sixty patients undergoing spinal surgery were randomly divided into three groups (n = 20 each). Dexmedetomidine 0.5μg/kg was intravenously pumped 15 min before anesthesia induction (group A) or 30 min before the end of surgery (group B). While equal volume of normal saline was given in group C. All groups started catheterization after endotracheal intubation. Recorded operation time, the time for recovery of spontaneous breathing, recovery time, extubation time, CRBD score and Ramsay score 5 min (T1), 30 min (T2), 1 hour (T3) after extubation were also recorded. Results Compared with group C, no significant difference was found in CRBD score in group A (P > 0.05). CRBD score was significantly decreased in group B at T1-3 (P < 0.05). Compared with group A, CRBD score at T2-3 was significantly decreased in group B (P < 0.05). At T1-3, Ramsay score in group B was significantly higher than that in group A and group C (P < 0.05). There was no significant difference in operation time, spontaneous breathing time, recovery time or extubation time among the three groups (P > 0.05). Conclusions Dexmedetomidine application 30 min before the end of surgery can effectively prevent the occurrence of CRBD during recovery from anesthesia in patients undergoing general anesthesia and doesn’t prolong the anesthesia recovery time.