术中右美托咪定对经尿道膀胱肿瘤切除术患者术后导尿管相关膀胱不适的影响：一项双盲随机研究。

The effect of intraoperative dexmedetomidine on postoperative catheter-related bladder discomfort in patients undergoing transurethral bladder tumour resection: A double-blind randomised study.

作者信息

Kim Hyun-Chang, Lee Yong-Hun, Jeon Young-Tae, Hwang Jung-Won, Lim Young-Jin, Park Jung-Eun, Park Hee-Pyoung

机构信息

From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul (HCK, YHL, YJL, JEP, HPP), and Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea (YTJ, JWH).

出版信息

Eur J Anaesthesiol. 2015 Sep;32(9):596-601. doi: 10.1097/EJA.0000000000000196.

DOI:10.1097/EJA.0000000000000196

PMID:25485879

Abstract

BACKGROUND

Catheter-related bladder discomfort (CRBD) due to an indwelling urinary catheter causes postoperative distress. Dexmedetomidine is used as an anaesthetic adjuvant during general anaesthesia and has an antimuscarinic effect, which may be beneficial for the prevention and treatment of CRBD.

OBJECTIVE

To determine the effect of intraoperative dexmedetomidine administration on the incidence of CRBD.

DESIGN

A double-blind, placebo-controlled, randomised study.

SETTING

A tertiary care teaching hospital.

PATIENTS

One-hundred and nine patients undergoing transurethral bladder tumour excision (TURB).

INTERVENTIONS

Patients were randomly allocated to two groups: control group (n = 55) received placebo and dexmedetomidine group (n = 54) received intraoperative dexmedetomidine (1 μg kg(-1) loading dose followed by 0.5 μg kg(-1) h(-1) continuous infusion).

MAIN OUTCOME MEASURES

The incidence and severity (mild, moderate, severe) of CRBD assessed at 0, 1, 6 and 24 h postoperatively.

RESULTS

The incidence of CRBD was significantly higher in the control group at 0 (78 vs. 50%; P = 0.004), 1 (86 vs. 57%; P = 0.002) and 6 h (82 vs. 63%; P = 0.047) postoperatively. The incidence of moderate to severe CRBD was higher in the control group at 0 (38 vs. 11%; P = 0.002) and 1 h (29 vs. 7%; P = 0.006) postoperatively. The number of patients having CRBD treated with tramadol was higher in the control group (24 vs. 12; P = 0.006). The mean end-tidal desflurane concentration during the surgery was higher in the control group (4.5 vs. 3.9%; P = 0.04). The postoperative pain score (numerical rating scale: 0 to 10) was higher in the control group at 0 (4.6 vs. 2.7; P = 0.002), and 1 h (3.8 vs. 2.7; P = 0.041). The number of patients treated with opioids was higher in the control group (21 vs. 8; P = 0.011).

CONCLUSION

Intraoperative dexmedetomidine administration decreased the incidence and severity of early postoperative CRBD as well as intraoperative desflurane and postoperative opioid requirements in patients undergoing TURB.

TRIAL REGISTRATION IDENTIFIER

NCT01991223 (www.clinicaltrials.gov).

摘要

背景

留置导尿管导致的导管相关性膀胱不适（CRBD）会引起术后不适。右美托咪定在全身麻醉期间用作麻醉辅助剂，具有抗毒蕈碱作用，这可能对CRBD的预防和治疗有益。

目的

确定术中给予右美托咪定对CRBD发生率的影响。

设计

一项双盲、安慰剂对照、随机研究。

地点

一家三级护理教学医院。

患者

109例行经尿道膀胱肿瘤切除术（TURB）的患者。

干预措施

患者被随机分为两组：对照组（n = 55）接受安慰剂，右美托咪定组（n = 54）接受术中右美托咪定（1 μg/kg负荷剂量，随后以0.5 μg·kg⁻¹·h⁻¹持续输注）。

主要观察指标

术后0、1、6和24小时评估CRBD的发生率和严重程度（轻度、中度、重度）。

结果

术后0小时（78%对50%；P = 0.004）、1小时（86%对57%；P = 0.002）和6小时（82%对63%；P = 0.047），对照组CRBD的发生率显著更高。术后0小时（38%对11%；P = 0.002）和1小时（29%对7%；P = 0.006），对照组中至重度CRBD的发生率更高。对照组中接受曲马多治疗CRBD的患者数量更多（24例对12例；P = 0.006）。手术期间对照组的平均呼气末地氟烷浓度更高（4.5%对3.9%；P = 0.04）。术后0小时（4.6对2.7；P = 0.002）和1小时（3.8对2.7；P = 0.041），对照组的术后疼痛评分（数字评定量表：0至10）更高。对照组中接受阿片类药物治疗的患者数量更多（21例对8例；P = 0.011）。