全身麻醉下经尿道前列腺电切术后吗啡对下尿路不适的影响：一项随机临床研究。

Effect of morphine on lower urinary tract discomfort after transurethral resection of prostate under general anesthesia: a randomised clinical study.

机构信息

Department of Anesthesiology, Yeditepe University Hospital A.D. Kozyatagı, State Highway Ankara Cad. No: 102/104, Kozyatagi, Istanbul, Turkey,

出版信息

J Anesth. 2013 Oct;27(5):720-4. doi: 10.1007/s00540-013-1593-9. Epub 2013 Mar 20.

DOI:10.1007/s00540-013-1593-9

PMID:23512419

Abstract

BACKGROUND

Lower urinary tract (LUT) discomfort is a common complaint after transurethral resection of the prostate (TURP), and it may lead to agitation and restlessnes. We have evaluated the efficacy of morphine for preventing TURP-related LUT discomfort symptoms.

METHODS

This was a prospective randomised study including 60 patients (American Society of Anesthesiologists class I and II) who were scheduled to undergo TURP. The patients were divided into two equally sized groups (group M: morphine, group C: control). A standartized anesthesia method was used. Group M patients received morphine 0.04 mg/kg intravenous (iv) in 100 ml of normal saline followed by an infusion of morphine for 24 h (0.01 mg/kg/h); group C patients received 100 ml normal saline 20 min before the expected extubation time, followed by a normal saline infusion which looked identical to that of the morphine infusion. The incidences and severity of LUT discomfort, postoperative pain, sedation level, postoperative nausea and vomiting (PONV) and respiratory depression were recorded at 0, 1, 2, 6, 12 and 24 h postoperatively.

RESULTS

The incidence of LUT discomfort was lower in group M patients at all time points during the study (p < 0.05) except for 2 h postoperatively, and the severity of LUT discomfort was also lower this group at 0, 12 and 24 h postoperatively (p = 0.001, p = 0.04 and p = 0.02, respectively). Pain (numeric rating scale) scores were lower in group M patients at 0 (p = 0.003) and 6 h (p < 0.001). The need for rescue analgesic was lower in group M patients (19 patients in group C, 10 patients in group M; p = 0.04). The incidence of PONV was higher in group M patients (p = 0.03). The incidence of pruritus, respiratory depression and over-sedation were similar among the groups.

CONCLUSION

Based on these results, we conclude that morphine effectively reduces LUT discomfort after TURP at a cost of postoperative nausea and vomiting.

摘要

背景

下尿路（LUT）不适是经尿道前列腺切除术（TURP）后的常见主诉，可能导致躁动不安。我们评估了吗啡预防 TURP 相关 LUT 不适症状的疗效。

方法

这是一项前瞻性随机研究，纳入 60 例（美国麻醉医师协会 I 级和 II 级）拟行 TURP 的患者。患者分为两组（吗啡组 M：吗啡 0.04mg/kg 静脉推注 100ml，随后以 0.01mg/kg/h 的速度输注吗啡；对照组 C：100ml 生理盐水，在预计拔管时间前 20min 输注，随后输注外观与吗啡输注相同的生理盐水）。记录术后 0、1、2、6、12 和 24h 时 LUT 不适、术后疼痛、镇静程度、术后恶心呕吐（PONV）和呼吸抑制的发生率和严重程度。

结果

在研究期间的所有时间点，M 组患者的 LUT 不适发生率均较低（p<0.05），除了术后 2h，且该组患者在术后 0、12 和 24h 时 LUT 不适的严重程度也较低（p=0.001、p=0.04 和 p=0.02）。M 组患者在术后 0（p=0.003）和 6h（p<0.001）时疼痛（数字评分量表）评分较低。M 组患者需要解救镇痛的人数较少（C 组 19 例，M 组 10 例；p=0.04）。M 组患者 PONV 的发生率较高（p=0.03）。各组的瘙痒、呼吸抑制和过度镇静的发生率相似。