右美托咪定对腰椎内固定术后导尿管相关性膀胱刺激征和疼痛的影响

Effect of dexmedetomidine on the postoperative catheter-related bladder discomfort and pain in patients undergoing lumbar internal fixation

目的观察右美托咪定(DEX)对腰椎内固定术后导尿管相关性膀胱刺激征(CRBD)和疼痛的影响。方法选取拟行腰椎内固定患者82例,随机分为对照组和试验组,每组41例。对照组行常规全身麻醉,试验组在气管插管后静脉注射DEX 1μg/kg,且持续静脉泵入DEX 0.4μg/kg/h至切口关闭前为止。所有患者在麻醉诱导后均使用16F导尿管。记录所有患者术后1、6 h CRBD的发生情况及严重程度。通过数值评定量表(NRS)对患者术后1、6 h休息时的疼痛程度和术后满意度进行评定。记录患者术后曲马多用量。结果试验组患者术后1、6 h CRBD的发生率及疼痛NRS评分均显著低于对照组(P<0.05或0.01),术后曲马多用量亦少于对照组(P<0.05),术后1、6 h的满意度NRS评分则高于对照组(P<0.05)。两组患者术中低血压和心动过缓的发生率,以及术后恶心呕吐、口干、低血压、心动过缓的发生率和镇静等级的比较差异均无统计学意义(P>0.05)。结论DEX可降低腰椎内固定术后患者CRBD的发生率,减轻术后疼痛,提高术后满意度,值得推广。

Objective To explore the effect of dexmedetomidine(DEX)on the postoperative catheter-related bladder discomfort(CRBD)and pain in patients undergoing lumbar internal fixation.Methods A total of 82 patients undergoing lumbar internal fixation were randomly assigned to the Control Group and the Experimental Group,41 cases in each group.The Control Group received regular general anesthesia while the Experimental Group received intravenous injection of 1μg/kg DEX after tracheal intubation and continuous intravenous pumping of DEX 0.4μg/kg/h until the incision was closed.16 F catheters were used for all the patients after anesthesia induction.The incidence and severity of CRBD were recorded at 1,6 h after the operation.The numerical rating scale(NRS)was used to assessment the pain severity and satisfaction at 1,6 h after the operation.Postoperative usage of tramadol by the patients was recorded.Results The incidence of CRBD and NRS pain scores of the Experimental Group at 1,6 after the operation were all significantly lower than those in the Control Group(P<0.05 or 0.01).Postoperative usage of tramadol in the Experimental Group was significantly lower than that in the Control Group(P<0.05).NRS satisfaction scores in the Experimental Group were significantly higher than those in the Control Group at 1,6 h after the operation(P<0.05).There were no significant differences in the incidence of intraoperative hypotension and bradycardia,postoperative nausea and vomiting,dry mouth,hypotension and bradycardia,and sedation level between the two groups(P>0.05).Conclusion DEX could reduce the incidence of CRBD in patients undergoing lumbar internal fixation,relieve the postoperative pain and increase the postoperative satisfaction of patients.It is worth clinical promotion.