间苯三酚复合达克罗宁胶浆防治全麻患者麻醉恢复期导尿管相关膀胱刺激征的效果

摘要

Objective To evaluate the efficacy of phloroglucinol combined with dyclonine hydrochloride mucilage in preventing catheter-related bladder discomfort (CRBD)during recovery from anesthesia in patients under general anesthesia.Methods A total of 120 male patients scheduled for laparoscopic cholecystectomy under general anesthesia,aged 18-60 years,weighing 46-80 kg, ASA physical status I or II,were randomly divided into 3 groups (n=40 in each group):group of combination of phloroglucinol and dyclonine hydrochloride mucilage (group P),sufentanil group (group S)and control group (group C).After induction of general anesthesia,the patients in group P were tracheally incubated and then inj ected with 5 ml dyclonine hydrochloride mucilage per urethra.In the meantime,for patients of groups S and C,equal volume of normal saline was inj ected and paraffin oil was used to lubricate for urethral catheterization.The catheter was clamped and then reopened 30 min later.At 15 min before the end of surgery,80 mg Phloroglucinol,0.10 μg/kg sufentanil and an equal volume of normal saline were injected intravenously in group P,group S and group C,respec-tively.The catheter was removed when the patients were fully awake.The awakening time and extu-bation time were recorded.In addition,Riker sedation-agiation scale (SAS)score was documented at 5 min (T1),15 min (T2),30 min (T3),1 h (T4)and 2 h (T5)after extubation.The occurrence and severity of CRBD within 2 h after surgery,as well as occurrence of nausea and vomiting and respira- tory depression were recorded.Results Compared with group C,the SAS score at T1-T4and inci-dence and severity CRBD were decreased,whereas the emergence time and extubation time were pro-longed in group S.The SAS score at T1-T5,incidence and severity of CRBD were decreased (P<0.05),and no significant change was found in emergence time and extubation time in group P.Com-pared with group S,the SAS score at T1-T4was increased,whereas the SAS score at T5,incidence and severity of CRBD were decreased,and the emergence time and extubation time were shortened in group P (P<0.05).There was no significant difference in the incidence of nausea and vomiting,re-spiratory depression and extubation time among the three groups. Conclusion Dyclonine hydrochloride mucilage injected per urethra combined with phloroglucinolol injected intravenously at 1 5 min before the end of surgery can reduce the incidence and severity of CRBD during the recovery from anesthesia in the patients under general anesthesia.%目的 评价间苯三酚复合达克罗宁胶浆预防全麻患者麻醉恢复期导尿管相关膀胱刺激征(catheter-related bladder discomfort,CRBD)的效果.方法 择期全麻下拟行腹腔镜胆囊切除术男性患者 120 例,年龄18~60 岁,体重46~80 kg,ASA Ⅰ或Ⅱ级.采用随机数字表法将其分为三组,每组40 例:间苯三酚复合达克罗宁胶浆组(P组)、舒芬太尼组(S组)和对照组(C 组).P 组于全麻诱导行气管插管术后,经尿道口注入达克罗宁胶浆 5 ml,S组和 C 组于相同时点注入等容量生理盐水并用石蜡油润滑导尿管,之后行导尿术,导尿成功后夹闭导尿管,30 min 后打开.手术结束前15 min P组静脉注射间苯三酚80 mg,S组静脉注射舒芬太尼0.10 μg/kg,C组给予等容量生理盐水5 ml.术后待患者完全清醒后拔除导尿管.记录苏醒时间、气管导管拔除时间及拔除气管导管后 5 min(T1)、15 min(T2)、30 min(T3)、1 h(T4)、和 2 h(T5)Riker 镇静-躁动评分;记录导尿管拔除时间,记录术后 2 h内 CRBD的发生情况及其程度以及恶心呕吐和呼吸抑制的发生情况.结果 与 C组比较,S组苏醒时间和气管导管拔除时间明显延长,T1~T4时Riker镇静-躁动评分、CRBD发生率和程度明显降低(P<0.05);P组T1~T5时 Riker镇静-躁动评分、CRBD发生率和程度明显降低(P<0.05).与 S组比较,P组苏醒时间和气管拔管时间明显缩短,T1~T4时 P 组 Riker 镇静-躁动评分明显升高,T5时 Riker镇静-躁动评分、CRBD发生率和程度明显降低(P<0.05 ).三组恶心呕吐、呼吸抑制发生率和导尿管拔除时间差异无统计学意义.结论 经尿道注入达克罗宁胶浆复合手术结束前 1 5 min静脉注射间苯三酚,可明显减少全麻患者麻醉恢复期 CRBD的发生,并减轻其严重程度,效果优于舒芬太尼.