右美托咪定联合达克罗宁胶浆镇痛对泌尿外科全麻病人术后导尿管相关性膀胱刺激征发生的影响

目的 探讨右美托咪定联合达克罗宁胶浆镇痛对泌尿外科全麻病人术后导尿管相关性膀胱刺激征(CRBD)发生的影响。 方法 选择行全麻手术的男性病人90例，根据随机数字表法分为右美托咪定组(D组)、右美托咪定联合达克罗宁胶浆(DD组)和对照组(C组)，各30例。D组和DD组于麻醉诱导前静脉泵注1.0 μg/kg右美托咪定，DD组在诱导后常规消毒外阴及尿道口，经尿道注入5 mL达克罗宁胶浆镇痛，并将2 mL达克罗宁胶浆均匀涂抹于导尿管上润滑，C组给予等量0.9%氯化钠溶液，行常规导尿术。观察并比较3组病人麻醉诱导前(T₀)、拔管前(T₁)、拔管时(T₂)及拔管后15 min(T₃)时刻的血流动力学指标变化、躁动评分(RS评分)、Ramsay镇静评分、麻醉恢复时间及术后CRBD发生率与程度。 结果 与T₀时刻比较，C组T₁、T₂、T₃时刻收缩压(SBP)、舒张压(DBP)、心率(HR)均明显升高(P < 0.05)，D组T₁、T₂时刻SBP、DBP、HR明显升高(P < 0.05)，而DD组无明显变化(P>0.05)；与C组比较，D组T₂、T₃时刻SBP、HR和T₂时刻DBP及DD组T₁、T₂、T₃时刻SBP、HR和T₂时刻DBP均较低(P < 0.05)，与D组比较，DD组T₁、T₂时刻SBP较低(P < 0.05)，其余比较差异均无统计学意义(P>0.05)；与T₀时刻比较，D组、DD组T₁、T₂、T₃时刻RS评分、Ramsay镇静评分均明显降低(P < 0.05)，而C组无明显变化(P>0.05)；与C组比较，D组及DD组各时间点RS评分均较低(P < 0.05)，Ramsay镇静评分较高(P < 0.05)；与D组比较，DD组各时间点RS评分差异均无统计学意义(P>0.05)，Ramsay镇静评分除T₀时刻无统计学意义外，其他各时间点评分均较高(P < 0.05)。3组呼吸恢复时间、苏醒时间及拔管时间比较差异均无统计学意义(P>0.05)；与C组比较，D组及DD组术后CRBD发生率较低(P < 0.01)，CRBD程度较轻(P < 0.01)；与D组比较，DD组术后CRBD发生率较低(P < 0.01)，CRBD程度较轻(P < 0.01)。 结论 右美托咪定联合达克罗宁胶浆镇痛可有效抑制泌尿外科全麻病人神经冲动，减少局部不良刺激，使麻醉过程中的血流动力学指标更平稳，减轻病人的痛苦和躁动程度，有效预防CRBD，并减轻病人的CRBD程度，增加导尿舒适性和安全性。

Effect of dexmedetomidine combined with dyclocainemucilage analgesia on the incidence rate of postoperative catheter related bladder discomfort after general anesthesia

Objective To investigate the effects of dexmedetomidine combined with dyclonine mucilage analgesia on the incidence rate of postoperative catheter related bladder discomfort(CRBD) after general anesthesia. Methods A total of 90 male patients with general anesthesia were divided into the dexmedetomidine group(group D), dexmedetomidine combined with dclonine mucilage(group DD) and control group(group C) according to the random number table method(30 cases each group). Before induction of anesthesia, the 1.0 μg/kg dexmedetomidine was intravenously injected into the group D and group DD. After induction, the vulva and urethral orifice in the group DD were routinely disinfected, and the 5 mL dacronine glue was injected into the group DD through the urethra for analgesia, and 2 mL dacronine glue was evenly smeared on the urethra for lubrication. The group C were treated with equal amount of 0.9% sodium chloride solution for routine urethral catheterization. The changes of hemodynamic indexes, agitation score(RS score), Ramsay sedation score, anesthesia recovery time and incidence rate and degree of postoperative CRBD in three groups were observed and compared before anesthesia induction(T₀), before extubation(T₁), during extubation(T₂) and after 15 min of extubation(T₃). Results Compared with T₀, the systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) in the group C at T₁, T₂ and T₃ significantly increased(P < 0.05), the SBP, DBP and HR in group D at T₁ and T₂ significantly increased(P < 0.05), while there were not significant changes in the group DD(P>0.05).Compared with the group C, the SBP and HR at T₂ and T₃, and DBP at T₂ in the group D were lower(P < 0.05), and the SBP and HR at T₁, T₂ and T₃, and DBP at T₂ in the group DD were lower(P < 0.05).Compared with the group D, the SBP in the group DD at T₁ and T₂ were lower(P < 0.05), and there was no significant difference in the rest(P>0.05).Compared with the T₀, the RS score and Ramsay sedation score in the group D and DD at T₁, T₂ and T₃ were significantly decreased(P < 0.05), while there were not significant changes in group C(P>0.05).Compared with the group C, the RS scores were lower(P < 0.05), and the Ramsay sedation scores were higher in the group D and group DD at each time point(P < 0.05).Compared with the group D, the differences of the RS scores in group DD among all time points were not statistically significant(P>0.05), and the Ramsay sedation scores at all time points except T₀ were higher(P < 0.05).The differences of the respiratory recovery time, recovery time and extubation time among three groups were not statistrically significant(P>0.05).Compared with the group C, the incidence rate of postoperative CRBD in group D and group DD were lower(P < 0.01), and the degree of CRBD was less(P < 0.01).Compared with the group D, the incidence rate of postoperative CRBD in group DD was lower(P < 0.01), and the degree of CRBD was milder(P < 0.01). Conclusions The dexmedetomidine combined with dyclonine mucilage analgesia can effectively inhibit the nerve impulses of patients with general anesthesia in the department of urology, reduce the local adverse stimulation, make hemodynamic parameters more stable in the process of anesthesia, relieve the degree of agitation and suffering of patients, effectively prevent the CRBD, reduce the level of the CRBD and increase the comfort and safety of urethral catheterization.