复方利多卡因乳膏复合羟考酮预防经尿道膀胱肿瘤电切术后导尿管相关膀胱不适的有效性

Efficacy of compound lidocaine cream combined with oxycodone in the prevention of catheter-related bladder discomfort after transurethral resection of bladder tumor

目的探讨复方利多卡因乳膏复合羟考酮预防经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)后导尿管相关膀胱不适(catheter-related bladder discomfort,CRBD)的有效性。方法选择2020年7月至12月全身麻醉下行TURBT的男性患者135例,随机分为3组:复方利多卡因乳膏组(L组)、羟考酮组(O组)和复方利多卡因乳膏复合羟考酮组(LO组),每组45例。L组患者使用复方利多卡因乳膏润滑导尿管后行尿管置入术;O组常规使用水溶性润滑剂润滑导尿管,并在预计手术结束前20 min静注羟考酮0.05 mg/kg;LO组患者同时采用以上两种方法。记录患者入苏醒室即刻(T1)、入室30 min(T2)、入室60 min(T3)CRBD的发生率、严重程度以及具体症状(“尿意”“疼痛”“憋胀”)的发生率。记录患者苏醒期不良反应发生情况和血流动力学指标。结果共剔除12例患者,最终纳入统计123例。T1时刻,LO组中重度CRBD的发生率显著低于L组(P<0.017);T2时刻,LO组CRBD发生率显著低于L组(P<0.017)。LO组与O组相比,T1、T2、T3时刻CRBD的发生率和严重程度,差异均无统计学意义(P>0.017)。T1时刻LO组“疼痛”发生率为7.1%,显著低于L组(41%;RR=5.744,95%CI 1.810~18.203)和O组(28.6%;RR=4.000,95%CI 1.216~13.157);LO组患者“憋胀”的发生率为16.7%,显著低于L组(46.2%;RR=2.769,95%CI 1.300~5.900)和O组(38.1%;RR=2.286,95%CI 1.049~4.978)。3组患者苏醒期不良反应及血流动力学参数,差异无统计学意义。结论在接受TURBT的男性患者中,复方利多卡因乳膏和羟考酮联合应用与单用复方利多卡因乳膏相比,可以降低苏醒早期CRBD的发生率,并减轻患者“疼痛”“憋胀”的不适症状。

Objective To evaluate the efficacy of compound lidocaine cream combined with oxycodone in the prevention of catheter-related bladder discomfort(CRBD)after transurethral resection of bladder tumor(TURBT).Methods A total of 135 male patients receiving TURBT under general anesthesia from July 2020 to December 2020 were randomly divided into three groups:compound lidocaine cream group(group L),oxycodone group(group O)and compound lidocaine cream combined with oxycodone group(group LO),with 45 cases of each group.The urethral catheter of patients in group L were lubricated with compound lidocaine cream,and patients in group O were treated with water-soluble lubricant and intravenously injected oxycodone 0.05 mg/kg 20 minutes before the end of the operation,and patients in group LO were treated with the two methods described above.The incidence,symptoms and severity of CRBD were recorded as soon as the patients entered the PACU(T1),30 min(T2)and 60 min(T3)after entering the PACU.During the recovery period,adverse reactions and hemodynamic indexes were recorded.Results A total of 12 patients were excluded and finally 123 cases were analyzed.At T1,the severity rate of CRBD in group LO was significantly lower than that in group L(P<0.017),and at T2,the incidence of CRBD in group LO was significantly lower than that in group L(P<0.017).There was no significant difference in the incidence and severity of CRBD between the group LO and the group O(P>0.017).At T1,the incidence of“pain”in group LO was significantly lower than that in group L(RR=5.744,95%CI 1.810-18.203)and group O(RR=4.000,95%CI 1.216-13.157),and the incidence of“flatulence”in group LO was significantly lower than that in group L(RR=2.769,95%CI 1.300-5.900)and group O(RR=2.286,95%CI 1.049-4.978).There was no significant difference in the incidence of adverse reactions and hemodynamic parameters among the three groups.Conclusions In male patients undergoing TURBT,compared with single administration of compound lidocaine cream,the combination of compound lidocaine cream and oxycodone could reduce the incidence of CRBD in the early stage of recovery,and relieve the uncomfortable symptoms of“pain”and“flatulence”.