利多卡因联合阿托品经尿道注射防治全麻后导尿管源性膀胱不适  

The effects of intravesical lidocaine in combination with atropine on catheter-related bladder discomfort

作　　者：鲁丹[1] 于巍[2] 李军[2] 马雪松[2] 戚思华[2] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,哈尔滨市150006 [2]哈尔滨医科大学附属第四医院麻醉科

出　　处：《临床麻醉学杂志》2013年第3期226-228,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察尿道注入利多卡因联合阿托品对全麻男性患者导尿管源性膀胱不适(cath-eter-related bladder discomfort,CRBD)的影响。方法择期手术男性患者72例,随机均分为四组。A组:阿托品1mg稀释至20ml;L组:2%利多卡因20ml;M组:2%利多卡因20ml联合阿托品1mg;N组:生理盐水20ml。各组患者于麻醉苏醒前30min通过导尿管注入上述溶液,注入完毕后用导尿管夹夹闭导尿管。于苏醒后患者Ramsay镇静评分为2分时(苏醒后0h)开放导尿管夹。于苏醒后0、1、2、6和12h时访视患者行CRBD评分。结果与M组比较,苏醒后0、1hA、L、N组CRBD评分显著升高(P<0.05),有CRBD症状患者例数明显增多(P<0.05);与N组比较,苏醒后0h时A、L组CRBD评分明显降低,有CRBD症状患者例数明显减少(P<0.05)。与N组比较,苏醒后0h时A、M组对CRBD评分为2分的预防效果较好,苏醒后1hM组CRBD评分为2分的患者例数明显减少(P<0.05)。结论麻醉苏醒前经尿道注入阿托品联合利多卡因能减少全麻苏醒时和苏醒后1h时CRBD症状的发生,并减轻其严重程度。Objective To evaluate the effects of intravesical lidocaine in combination with atropine on catheter-related bladder discomfort in male patients after general anesthesia. Methods Seventy-two male adult patients undergoing selective surgery were randomized into four groups（n=18 each）, group A,diluated atropine 20 ml% group L,2% lidocaine 20 ml; group M, 2% lidocaine 20 ml mixed atropine lmg; group N, 0.9% normal saline 20 ml. All patients received intravesical medication 30 minutes before emergence of anesthesia. Right after drug ad ministration, the urinary catheters were tightly clamped. Bladder discomfort was assessed with CRBD score after tracheal intubation was removed and Ramsay sedation scale reached 2. The CRBD was assessed at 0, 1,2,6 h and 12 h after revival. Severity of CRBD was graded as none, mild, moderate and severe. Results Compared with other groups at 0 h and 1 h after revival, CRBD score of group M significantly lower and incidence of CRBD symptoms was much lower than other groups（P〈0.05） ; Compared with group N at 0 h after revival, groups A and L had the lighter symptom of CRBD（P〈0.05）, and there is no difference between the two groups. Compared with group N at 0 h after revival, both groups A and M had better effect of prevention for moderate CRBD without any difference between the two groups. Compared with group N at 1 h after revival, group M had less patients with moderate CRBD （P〈0.05）. Conclusion The combination of atropine and lidocaine injected into the urethral of male patients during general anesthesia can reduce the incidence of CRBD at 1 h after revival.

关 键 词：阿托品 利多卡因 导尿管源性膀胱不适 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]