超声引导下双侧阴部神经阻滞预防输尿管镜碎石术后导尿管相关膀胱刺激征的效果

Efficacy of ultrasound-guided bilateral pudendal nerve block to prevent catheter-related bladder discomfort after ureteroscopic lithotripsy

中文关键词: 超声引导  双侧阴部神经阻滞  输尿管镜碎石术  导尿管相关膀胱刺激征

英文关键词: Ultrasound-guided  Bilateral pudendal nerve block  Ureteroscopic lithotripsy  Catheter-related bladder discomfort

中文摘要:

      
目的 探讨超声引导下双侧阴部神经阻滞（PNB）预防全麻下输尿管镜碎石术后导尿管相关膀胱刺激征（CRBD）的效果。
方法 选择择期全麻下行输尿管镜碎石术的男性患者104例，年龄18～64岁，BMI 20～27 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：阻滞组和对照组，每组52例。阻滞组在麻醉诱导前予双侧PNB，对照组不做处理，两组麻醉诱导及维持方法相同。记录拔管后12 h内CRBD发生情况和严重程度。记录拔管即刻、拔管后30 min、4、8、12 h时VAS疼痛评分、躁动评分和Ramsay评分。记录拔管后12 h内曲马多追加情况。记录术后48 h内口干、寒战、恶心呕吐、呼吸抑制、过度镇静等不良反应的发生情况。
结果 拔管后12 h内，阻滞组CRBD发生率明显低于对照组（P<0.05），阻滞组CRBD严重程度明显低于对照组（P<0.05）。拔管即刻、拔管后30 min、4 h时，阻滞组VAS疼痛评分明显低于对照组（P<0.05）；拔管后30 min、4、8、12 h时，阻滞组躁动评分明显低于对照组（P<0.05）；拔管即刻、拔管后30 min、4、8 h时，阻滞组Ramsay评分明显高于对照组（P<0.05）。拔管后12 h内阻滞组曲马多追加率明显低于对照组（P<0.05）。术后48 h内阻滞组口干和恶心呕吐发生率明显低于对照组（P<0.05）。术后48 h内两组寒战、呼吸抑制和过度镇静发生率差异无统计学意义。
结论 超声引导下双侧PNB预防全麻下输尿管镜碎石术后患者CRBD的发生具有良好效果，有助于降低CRBD的发生率以及严重程度，且不良反应发生率更低。

英文摘要:

      
Objective To explore the efficacy of ultrasound-guided bilateral pudendal nerve block (PNB) in preventing catheter-related bladder discomfort (CRBD) after ureteroscopic lithotripsy under general anesthesia.
Methods A total of 104 male patients underwent elective ureteroscopic lithotripsy were selected, aged 18-64 years, BMI 20-27 kg/m², ASA physical status Ⅰ or Ⅱ. According to the random number table method, patients were divided into two groups: nerve block group and control group, 52 patients in each group. Nerve block group was given ultrasound-guided bilateral PNB before anesthesia induction, and control group was not treated. The
Methods of anesthesia induction and maintenance were same in the two groups. The occurrence and severity of CRBD within 12 hours after extubation were recorded. The VAS score, agitation score and Ramsay score were recorded at the time of tracheal extubation, 30 minutes, 4, 8 and, 12 hours after extubation. Tramadol addition within 12 hours after extubation was recorded. Dry mouth, shivering, nausea and vomiting, respiratory depression, and excessive sedation were recorded within 48 hours in the two groups.
Results Compared with the control group, the incidence and severity of CRBD in nerve block group were significantly decreased (P < 0.05). The VAS score of nerve block group were significantly lower than control group at the time of tracheal extubation, 30 minutes, 4 hours after extubation (P < 0.05). At 30 minutes, 4, 8 and 12 hours after extubation, the agitation score of nerve block group were significantly lower than control group (P < 0.05). The Ramsay score in nerve block group were significantly higher than control group at the time of tracheal extubation, 30 minutes, 4, 8 hours after extubation. Within 12 hours after extubation, the use of additional tramadol in nerve block group were significantly less than that in control group (P < 0.05). Compared with control group, the incidence of nausea and vomiting and mouth dry in nerve block group were decreased within 48 hours after surgery (P < 0.05). There were no significant differences in the incidence of respiratory depression, excessive sedation and shrivering in the two groups within 48 hours after surgery.
Conclusion Ultrasound-guided bilateral PNB has a good effect on preventing the occurrence of CRBD in patients after ureteroscopic lithotripsy under general anesthesia, which helps to reduce the incidence of severe CRBD and the incidence of adverse reactions.