超声引导下髂腹下-髂腹股沟神经阻滞应用于男性全身麻醉后导尿管相关膀胱刺激征临床效果的回顾性研究

Retrospective Study on the Clinical Effect of Ultrasound-Guided Ilio-Hypoabdominal/Ilio-Inguinal Nerve Block on Catheter-Related Bladder Discomfort after General Anesthesia in Male

目的:探讨超声引导髂腹下-髂腹股沟神经阻滞应用于男性全身麻醉后导尿管相关膀胱刺激征(CRBD)的临床效果。方法:回顾性分析本院收治的60例择期全身麻醉下行下肢清创、皮瓣转移或植皮的男性患者,且术中需留置导尿管者的临床资料。按是否行超声引导下髂腹下-髂腹股沟神经阻滞分为观察组和对照组,观察组在全身麻醉后,超声引导下进行双侧髂腹下-髂腹股沟神经阻滞,神经阻滞完成后行导尿管留置术。对照组麻醉诱导完成后,即行导尿管留置术。记录拔除气管导管后10 min(T1)、1h(T2)、3h(T3)CRBD严重程度评分和Riker镇静-躁动评分。记录术前(T0)和T1、T2、T3对应时点的收缩压(SBP)、舒张压(DBP)、心率(HR),对比两组的苏醒质量和麻醉相关不良反应。结果:术后各时段观察组CRBD严重程度评分和Riker镇静-躁动评分均明显低于对照组(P<0.05);术后各时段观察组的SBP、DBP、HR与对照组相比均明显降低(P<0.05);观察组PACU内非计划性使用镇痛药、非计划性拔除尿管的比例低于对照组,PACU的停留时间短于对照组(P <0.05);两组麻醉相关不良反应发生率对比未见统计学意义(P>0.05)。结论:超声引导下髂腹下-髂腹股沟神经阻滞操作简便,减轻全身麻醉后CRBD的效果确切,患者对导尿管有良好的耐受,术后血流动力学和循环更稳定,苏醒质量更高。

Objective:To investigate the clinical effect of ultrasound-guided ilio-hypoabdominal/ilio-inguinal nerve block on catheter-related bladder discomfort(CRBD)after general anesthesia in male.Methods:The clinical data of 60 male patients with lower extremity debridement,skin flap transfer or skin grafting under elective general anesthesia who needed indwelling catheter in our hospital were retrospectively analyzed.The patients were divided into observation group and control group according to whether ultrasound-guided ilio-hypoabdominal/ilio-inguinal nerve block was performed.After general anesthesia,the observation group was subjected to ultrasound-guided ilio-hypoabdominal/ilio-inguinal nerve block.After nerve block,catheter indwelling was performed.After anesthesia induction,the control group underwent catheter indwelling.CRBD severity score and Riker sedation agitation score were recorded 10 min(T1),1h(T2),3h(T3)after tracheal catheter removal.Systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were recorded before operation(T0)and at the corresponding time points of T1,T2 and T3,The awakening quality and anesthesia related adverse reactions were compared between the two groups.Results:The CRBD severity score and Riker sedation agitation score in the observation group at each period after operation were significantly lower than those in the control group(P<0.05).The SBP,DBP and HR in the observation group were significantly lower than those in the control group at each period after operation(P<0.05).The proportion of unplanned use of analgesics and unplanned removal of urinary catheter in PACU in the observation group were lower than those in the control group,and the PACU residence time was shorter than that in the control group(P<0.05).There was no significant difference in the incidence of anesthesia related adverse reactions between the two groups(P>0.05).Conclusion:Ultrasound-guided ilio-hypoabdominal/ilio-inguinal nerve block is easy to operate and has a definite effect on reducing CRBD after general anesthesia.The patients have good tolerance to urinary catheters,more stable postoperative hemodynamics and circulation,and higher quality of awakening.