镁与经尿道膀胱肿瘤切除术术后膀胱不适：一项随机、双盲、安慰剂对照研究。

Magnesium and Bladder Discomfort after Transurethral Resection of Bladder Tumor: A Randomized, Double-blind, Placebo-controlled Study.

机构信息

From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-Y.P.. D.-H.K., J.Y., J.-H.H., Y.-K.K.) the Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.H.H.).

出版信息

Anesthesiology. 2020 Jul;133(1):64-77. doi: 10.1097/ALN.0000000000003309.

DOI:10.1097/ALN.0000000000003309

PMID:32304405

Abstract

BACKGROUND

Catheter-related bladder discomfort occurs because of involuntary contractions of the bladder smooth muscle after urinary catheterization. Magnesium is associated with smooth muscle relaxation. This study hypothesized that among patients having transurethral resection of bladder tumor, magnesium will reduce the incidence of postoperative moderate-to-severe catheter-related bladder discomfort.

METHODS

In this double-blind, randomized study, patients were randomly allocated to the magnesium group (n = 60) or the control group (n = 60). In magnesium group, a 50 mg/kg loading dose of intravenous magnesium sulfate was administered for 15 min, followed by an intravenous infusion of 15 mg · kg · h during the intraoperative period. Patients in the control group similarly received normal saline. The primary outcome was the incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively. None, mild, moderate, and severe catheter-related bladder discomfort at 1, 2, and 6 h postoperatively, patient satisfaction, and magnesium-related adverse effects were also assessed.

RESULTS

The incidence of catheter-related bladder discomfort above a moderate grade at 0 h postoperatively was significantly lower in the magnesium group than in the control group (13 [22%] vs. 46 [77%]; P < 0.001; relative risk = 0.283; 95% CI, 0.171 to 0.467; absolute risk reduction = 0.55; number needed to treat = 2); similar results were observed for catheter-related bladder discomfort above a moderate grade at 1 and 2 h postoperatively (5 [8%] vs. 17 [28%]; P = 0.005; relative risk = 0.294; 95% CI, 0.116 to 0.746; and 1 [2%] vs. 14 [23%]; P < 0.001; relative risk = 0.071; 95% CI, 0.010 to 0.526, respectively). Patient satisfaction on a scale from 1 to 7 was significantly higher in the magnesium group than in the control group (5.1 ± 0.8 vs. 3.5 ± 1.0; P < 0.001; 95% CI, 1.281 to 1.919). Magnesium-related adverse effects were not significantly different between groups.

CONCLUSIONS

Magnesium reduced the incidence of catheter-related bladder discomfort above a moderate grade and increased patient satisfaction among patients having transurethral resection of bladder tumor.

摘要

背景

导尿管相关性膀胱不适是由于导尿后膀胱平滑肌的不随意收缩引起的。镁与平滑肌松弛有关。本研究假设在接受经尿道膀胱肿瘤切除术的患者中，镁将降低术后中重度导尿管相关性膀胱不适的发生率。

方法

在这项双盲、随机研究中，患者被随机分配到镁组（n = 60）或对照组（n = 60）。在镁组中，给予 50mg/kg 的静脉注射硫酸镁负荷剂量，持续 15 分钟，然后在手术期间以 15mg·kg·h 的速度静脉输注。对照组患者同样给予生理盐水。主要结局是术后 0 小时时中重度以上的导尿管相关性膀胱不适的发生率。术后 1、2 和 6 小时时的轻度、中度、重度导尿管相关性膀胱不适、患者满意度以及与镁相关的不良反应也进行了评估。

结果

术后 0 小时时中重度以上的导尿管相关性膀胱不适的发生率在镁组明显低于对照组（13 [22%] vs. 46 [77%]；P < 0.001；相对风险 = 0.283；95%CI，0.171 至 0.467；绝对风险降低 = 0.55；需要治疗的人数 = 2）；术后 1 和 2 小时时中重度以上的导尿管相关性膀胱不适也有类似的结果（5 [8%] vs. 17 [28%]；P = 0.005；相对风险 = 0.294；95%CI，0.116 至 0.746；1 [2%] vs. 14 [23%]；P < 0.001；相对风险 = 0.071；95%CI，0.010 至 0.526）。镁组患者的满意度评分（1 至 7 分）明显高于对照组（5.1 ± 0.8 vs. 3.5 ± 1.0；P < 0.001；95%CI，1.281 至 1.919）。两组之间镁相关不良反应无显著差异。