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| 膀胱灌注与静脉泵注右美托咪定对腹腔镜全子宫切除术患者导尿管相关膀胱刺激征影响的比较 |
| Comparison of the effects of bladder irrigation and intravenous pumping of dexmedetomidine on catheter-related bladder discomfort in patients undergoing laparoscopic total hysterectomy |
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| DOI：10.12089/jca.2025.07.003 |
| 中文关键词: 右美托咪定 膀胱灌注 静脉泵注 导尿管相关膀胱刺激征 全子宫切除术 |
| 英文关键词: Dexmedetomidine Bladder irrigation Intravenous pumping Catheter-related bladder discomfort Total hysterectomy |
| 基金项目:国家自然科学基金青年科学基金项目（82001169） |
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| 中文摘要: |
目的：观察和比较膀胱灌注与静脉泵注右美托咪定对腹腔镜全子宫切除术患者导尿管相关膀胱刺激征（CRBD）的影响。
方法：选择腹腔镜全子宫切除术患者120例，年龄30～70岁，BMI 18.5～25.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：静脉泵注右美托咪定组（A组）、膀胱灌注右美托咪定组（B组）和对照组（C组），每组40例。麻醉诱导前，A组通过导尿管向膀胱注入生理盐水20 ml，同时静脉泵注右美托咪定1 μg·kg-1·h-1，10 min后改为0.5 μg·kg-1·h-1持续泵注30 min；B组将右美托咪定0.5 μg/kg溶于生理盐水20 ml，通过导尿管注入膀胱；C组通过导尿管向膀胱注入生理盐水20 ml。记录手术时间、麻醉时间、苏醒时间、拔管时间和PACU停留时间。记录拔除气管导管时（拔管时）、拔除气管导管后（拔管后）1、2、6、12、24 h CRBD发生情况和尿道VAS疼痛评分，评估CRBD严重程度。记录术中瑞芬太尼、术后48 h内舒芬太尼用量、镇痛泵有效按压次数。记录术后24 h内低血压、心动过缓、恶心呕吐、嗜睡等不良反应的发生情况。
结果：与C组比较，A组和B组苏醒时间、拔管时间和PACU停留时间明显缩短，术中瑞芬太尼、术后48 h内舒芬太尼用量及镇痛泵有效按压次数明显减少（P<0.05）；A组拔管时、拔管后1、2、6 h中重度CRBD发生率明显降低，拔管时、拔管后1、2、6、12 h CRBD总发生率、尿道VAS疼痛评分明显降低，低血压、心动过缓发生率明显升高（P<0.05）；B组拔管时、拔管后1、2、6、12、24 h中重度CRBD发生率、CRBD总发生率、尿道VAS疼痛评分明显降低（P<0.05）。与A组比较，B组拔管后12、24 h尿道VAS疼痛评分明显降低，术后48 h内舒芬太尼用量及镇痛泵有效按压次数明显减少（P<0.05）。
结论：膀胱灌注或静脉泵注右美托咪定均能有效降低腹腔镜全子宫切除术患者术后尿道疼痛程度，降低CRBD发生率及严重程度，且膀胱灌注的效果更好。 |
| 英文摘要: |
Objective: To observe and compare the effects of bladder irrigation and intravenous pumping of dexmedetomidine on catheter-related bladder discomfort (CRBD) in patients undergoing laparoscopic total hysterectomy.
Methods: A total of 120 patients undergoing laparoscopic total hysterectomy, aged 30-70 years, BMI 18.5-25.0 kg/m2, ASA physical status Ⅰor Ⅱ, were selected. The patients were randomly divided into three groups using a random number table method: intravenous infusion of dexmedetomidine group (group A), bladder instillation of dexmedetomidine group (group B), and control group (group C), 40 patients in each group. Before general anesthesia, normal saline 20 ml was injected into the bladder through a ureteral cathete, then intravenous infusion of dexmedetomidine 1 μg·kg-1·h-1 was administered simultaneously, and the dosage was changed 10 minutes later to 0.5 μg·kg-1·h-1 for 30 minutes in group A. Dexmedetomidine 0.5 μg/kg was dissolved in 20 ml of normal saline and injected into the bladder through a ureteral cathete in group B. Normal saline 20 ml was injected into the bladder through a ureteral cathete in group C. The anesthesia time, surgical time, awaking time, extubation time, and time of leaving the PACU were recorded. The incidence of CRBD, and urethral VAS pain score at extubation of the endotracheal tube, 1, 2, 6, 12, and 24 hours after extubation of the endotracheal tube were recorded. And the severity of CRBD was also evaluated. The intraoperative remifentanil, dosage of sufentanil within 48 hours after the operation, effective compressions of the analgesic pump, and incidence of postoperative adverse reactions within 24 hours after the operation (hypotension, bradycardia, nausea, vomiting and drowsiness occurred) were recorded.
Results: Compared with group C, the awakening time, extubation time, and PACU stay time were significantly shortened, the intraoperative remifentanil dosage, sufentanil dosage within 48 hours after surgery, and the effective compression times of the analgesic pump were significantly reduced in groups A and B (P < 0.05). Compared with group C, the incidence of moderate to severe CRBD at extubation of the endotracheal tube, 1, 2, and 6 hours after extubation of the endotracheal tube was significantly decreased, the incidence of total CRBD and urethral VAS pain score at extubation, 1, 2, 6, and 12 hours after extubation were significantly decreased, while the incidences of hypotension and bradycardia were significantly increased in group A (P < 0.05). Compared with group C, the incidence of moderate to severe CRBD, the incidence of total CRBD, and the urethral VAS pain score at extubation, 1, 2, 6, 12, and 24 hours after extubation were significantly decreased in group B (P < 0.05). Compared with group A, the urethral VAS pain scores 12 and 24 hours after extubation were significantly decreased, the sufentanil dosage within 48 hours after surgery and the effective compression times of the analgesic pump were significantly reduced in group B (P < 0.05).
Conclusion: Bladder irrigation or intravenous pumping of dexmedetomidine can effectively reduce postoperative urethral pain and lower the incidence and severity of CRBD in patients undergoing laparoscopic total hysterectomy, and bladder instillation of dexmedetomidine has a more significant therapeutic effect. |
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