右美托咪啶镇静下留置导尿管降低胃肠道手术患者苏醒期尿道刺激的研究

Effect of indwelling catheter with dexmedetomidine sedation on urethral irritation in patients undergoing gastrointestinal surgery during recovery period

目的探讨右美托咪啶(DEX)镇静下留置导尿管降低腹腔镜胃肠道手术患者苏醒期尿道刺激的作用。方法选取2019年1月至2020年2月中山大学附属第三医院全麻下行择期腹腔镜胃肠道手术患者90例。电脑随机法分为3组:诱导前导尿组(A组)、诱导中导尿组(B组)、诱导后导尿组(C组)。A组清醒导尿再行全麻诱导;B组静脉泵注DEX 0.5μg/kg,10 min泵注完毕后导尿再行全麻诱导;C组全麻诱导后导尿。记录尿道刺激VAS评分、吗啡用量和苏醒期躁动发生率等。比较三组患者入室时、导尿时、气管插管时、入麻醉复苏室(PACU)时、即将拔管时、拔管后30 min的心率和平均动脉压。结果B组即将拔除气管导管时和拔除气管导管后30 min患者血压和心率波动幅度明显小于A组和C组(P<0.05)。留置尿管时B组尿道刺激VAS评分[(2.9±0.9)分]明显低于A组[(4.4±1.8)分](P<0.05);拔除气管导管后B组尿道刺激VAS评分[(2.8±1.1)分]明显低于A组[(3.2±1.2)分]和C组[(5.2±1.8)分](P<0.05)。B组术后24 h内吗啡使用率(10%)明显低于A组(40%)和C组(57%)(P<0.05),PACU内A组(27%)和B组(13%)术后躁动发生率低于C组(67%)(P<0.05);B组患者满意度(86.7%)高于A组(70%)和C组(46.7%)(P<0.05);A组(76.7%)和B组(80.0%)PACU人员满意度明显高于C组(43.3%)(P<0.05)。结论右美托咪啶镇静下留置导尿管可降低腹腔镜胃肠道手术患者苏醒期尿道刺激和躁动,提高患者、PACU医护满意度。

Objective To investigate the effect of dexmedetomidine(DEX)on reducing urethral stimulation in patients undergoing laparoscopic gastrointestinal surgery.Methods From January 2019 to February 2020,90 patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia in the Third Affiliated Hospital of Sun Yat-sen University were selected.They were randomly divided into 3 groups:catheterization before induction(group A),catheterization during induction(group B),and catheterization after induction(group C).In group A,patients received general anesthesia after awake catheterization.In group B,intravenous injection of DEX 0.5μg/kg was pumped for 10 minutes,followed by catheterization and induction.In group C,patients received general anesthesia and then catheterization.Visual analogue scale(VAS)score of urethral stimulation,morphine dosage and the incidence of agitation during resuscitation were recorded.The heart rate and mean arterial pressure of the three groups were compared at the time of entering the room,catheterization,tracheal intubation,entering postanesthesia care unit(PACU),about extubation and 30 minutes after extubation.Results The fluctuation of blood pressure and heart rate in group B was significantly less than that in group A and group C at the time of extubation and 30 minutes after extubation(P<0.05).VAS of urethral stimulation in group B[(2.9±0.9)point]was significantly lower than that in group A[(4.4±1.8)point]when catheter was indwelling(P<0.05).After extubation,VAS in group B[(2.8±1.1)point]was significantly lower than that in group A[(3.2±1.2)point]and C[(5.2±1.8)point](P<0.05).The utilization rate of morphine within 24 hours after surgery in group B(10%)was significantly lower than that in the other two groups(40%,57%),and the incidence of postoperative agitation in group A and B was lower than that in group C within PACU(P<0.05).The satisfaction of patients in group B(86.7%)was higher than that in group A(70%)and C(46.7%).The satisfaction of PACU personnel in group A(76.7%)and B(80%)was significantly higher than that in group C(43.3%).Conclusions Sedation with dexmedetomidine during urethral catheterization can reduce urethral stimulation during resuscitation and improve patients'and PACU staffs'satisfaction.