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| 喷他佐辛预防神经外科患者全麻恢复期导尿管相关膀胱刺激征的效果 |
| Preventive effect of pentazocine on urinary catheter-related bladder discomfort after general anesthesia in neurosurgery patients |
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| DOI：10.12089/jca.2019.05.012 |
| 中文关键词: 喷他佐辛 麻醉恢复期 导尿管插入术 膀胱刺激征 |
| 英文关键词: Pentazocine Anesthesia recovery period Urinary catheterization Bladder discomfort |
| 基金项目:安徽省国际科技合作计划资助项目（1503062021） |
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| 中文摘要: |
目的 评价喷他佐辛预防神经外科患者全麻恢复期导尿管相关膀胱刺激征（CRBD） 的效果。
方法 选择择期神经外科手术男性患者80例，年龄20~65岁，BMI 18~25 kg/m2， ASA Ⅰ或Ⅱ级，采用随机数字表法将其分为两组(n=40)：喷他佐辛组(P组)和对照组(C组)。两组静脉注射舒芬太尼0.4 μg/kg、依托咪酯0.25 mg/kg和罗库溴铵0.6 mg/kg行麻醉诱导，于诱导后行导尿术，选用16号导尿管，复方利多卡因乳膏充分涂抹润滑。术中靶控输注丙泊酚和瑞芬太尼维持麻醉，术毕P组静脉注射喷他佐辛0.6 mg/kg，C组注射等量生理盐水。记录两组患者术后4 h CRBD 发生情况和程度；记录曲马多的追加次数；于气管拔管即刻(T1)、拔管后 10 min(T2)、30 min(T3)、1 h(T4)和4 h(T5)时记录患者的躁动评分、NRS评分和Ramsay 评分；分别于术前1d、术后1d采用QoR-40量表评估患者术后早期恢复质量；记录两组患者术后恶心呕吐、呼吸抑制、头痛及视物模糊的发生情况。
结果 与C组比较，P组患者CRBD发生率及CRBD程度明显降低(P<0.01)，T1—T2时躁动评分明显降低(P<0.05)，T1—T5时NRS评分明显降低、Ramsay评分明显升高(P<0.05)，术后1 d的QoR-40总评分明显升高(P<0.05)，术后曲马多追加率明显降低(P<0.05)，恶心呕吐及头痛的发生率明显降低(P<0.05)，两组呼吸抑制及视物模糊的发生率差异无统计学意义。
结论 喷他佐辛可明显降低神经外科患者全麻恢复期导尿管相关膀胱刺激征的发生率及严重程度，更有利于提高患者早期恢复质量。 |
| 英文摘要: |
Ojective To evaluate the efficacy of Pentazocine preventing catheter-related bladder discomfort during recovery from anesthesia in neurosurgery patients.
Methods Eighty male patients underwent elective neurosurgery, aged 20 - 65 years, with a BMI 18 - 25 kg/m2，falling into ASA physical status Ⅰ or Ⅱ. All the patients were divided into two groups:pentazocine group(group P) and control group(group C).Anesthesia was induced by intravenous injection of sufentanil 0.4 μg/kg, etomidate 0.25 mg/kg,rocuronium 0.6 mg/kg.Urinary catheterization after induction of anesthesia. Urinary catheter 16F was selected and lubricated with compound lidocaine cream. Target-controlled infusion of propofol and remifentanil was used to maintain anesthesia. Before the end of surgery, group P received pentazocine 0.6 mg/kg whereas patients in group C received normal saline. The occurrence and severity of CRBD within 4 h after surgery were recorded，and record additional times use of tramadol. Agitation,NRS and Ramsay sedation scale scores were recorded at the time of tracheal extubation (T1), 10 min(T2), 30 min(T3), 1 h(T4) and 4 h (T5)after extubation. The 40-item quality of recovery questionnaire (QoR - 40) was used to assess early postoperative quality of recovery on preoperative day 1 and 1 days after surgery. PONV, respiratory depression, headache and blurred vision were recorded in both groups.
Results Compared with the group C, incidence and severity of CRBD were significantly decreased (P<0.01). In group P, the agitation score of T1 - T2 was decreased, the NRS score of T1 - T5 was decreased and Ramsay score was increased (P<0.05), the global QoR - 40 scores were higher on 1 days after surgery in group P (P <0.05), the rate of postoperative tramadol addition decreased and the incidence of PONV and headache decreased (P<0.05). There was no significant difference in the incidence of respiratory depression and blurred vision in the two groups.
Conclusion Pentazocine can significantly reduce the incidence and severity of CRBD in neurosurgery patients during the recovery period of general anesthesia,and is more conducive to improving the quality of early recovery of patients. |
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