右美托咪定对术后导尿管相关膀胱刺激征的影响

Effect of dexmedetomidine on postoperative urinary catheter⁃related bladder discomfort

目的 观察不同剂量右美托咪定对术后导尿管相关膀胱刺激征(CRBD)的影响,探讨右美托咪定与术后膀胱刺激征症状的量效关系,为临床选择适宜剂量提供依据。方法 选取择期全麻手术计划导尿的男性患者303例,分为生理盐水对照组(A组)、右美托咪定0.2μg/(kg·h)组(B组)、0.4μg/(kg·h)组(C组)和0.6μg/(kg·h)组(D组)。B、C、D组均在诱导前输注负荷剂量右美托咪定1μg/kg(10 min内泵注完成),后分别以0.2μg/(kg·h)、0.4μg/(kg·h)、0.6μg/(kg·h)的剂量泵注,A组给予等量生理盐水,手术结束前30 min停止。于恢复室(T0)、术后1 h(T1)、6 h(T2)、24 h(T3)评估患者CRBD的发生率及严重程度。记录术中药物使用情况及术后不良反应。结果 CRBD比较,在T0、T2时A组与B、C、D三组相比差异有统计学意义(P <0.05);在T1时A组与B、C、D三组以及B组与D组之间差异有统计学意义(P <0.05);在T3时C组、D组CRBD发生率低于A组(P <0.05)。在T0、T1、T2时D组中重度CRBD的发生率低于A组,差异有统计学意义(P <0.05)。在T0、T1、T2时4组之间的NRS评分差异有统计学意义(P <0.05)。在T3时,对照组NRS评分高于所有右美托咪定组,但右美托咪定组之间差异无统计学意义。随着右美托咪定剂量增加,术中瑞芬太尼和丙泊酚的使用量降低(P <0.05)。4组不良反应的发生率差异无统计学意义(P> 0.05)。结论 术中给予右美托咪定可降低术后CRBD的发生率。0.6μg/(kg·h)的剂量在降低CRBD发生率的同时可以降低严重程度,此剂量可提高患者的舒适度且无相关不良反应。

Objective To observe the effect of different doses of dexmedetomidine on catheter⁃related bladder discomfort(CRBD),to explore the appropriate dose of dexmedetomidine during operation.Methods A total of 303 male patients undergoing elective surgery under general anesthesia and planned to insert catheter were selected and randomly divided into four groups:normal saline control group(group A),dexmedetomidine 0.2μg/(kg·h)group(group B),0.4μg/(kg·h)group(group C),and 0.6μg/(kg·h)group(group D).Groups B,C and D were infused with loading dose of dexmedetomidine 1μg/kg before induction(completed by intravenous pumping within 10 min),and then were continuously pumped with 0.2μg/(kg·h),0.4μg/(kg·h),0.6μg/(kg·h)respectively.Group A was given the same amount of normal saline.The infusion was stopped until 30 minutes before the end of the operation.The incidence and severity of CRBD were evaluated at the postanesthesia care unit(PACU)(T 0),1 h(T 1),6 h(T 2),and 24 h(T 3)after operation.Intraoperative drug use and postoperative adverse events were recorded.Results The incidence of CRBD,at T 0,T 2,there were differences between group A and B,group A and C,and group A and D(P<0.05).At T 1,there were differences between group A and group B,group A and group C,group A and group D,and between group B and group D(P<0.05).At T 3,there were differences between group A and group C,and group A and group D(P<0.05).At T 0,T 1 and T 2,the incidences of moderate to severe CRBD in group D were statistically different from group A(P<0.05).The NRS scores of the four groups at T 0,T 1 and T 2 were statistically significant(P<0.05).At T 3,the control group was higher than that of the dexme⁃detomidine group,but there was no significant difference between the dexmedetomidine groups.The use of remifen⁃tanil and propofol decreased with the increase of dexmedetomidine dose,which was statistically significant among the four groups.There was no significant difference in the incidence of adverse reactions among the four groups(P>0.05).Conclusions Intraoperative administration of dexmedetomidine can reduce the incidence of postoper⁃ative CRBD,The dose of 0.6μg/(kg·h)can reduce the incidence and severity of CRBD,and this dose can improve the comfort of patients without related adverse reactions.