小剂量艾司氯胺酮对老年男性经输尿管镜碎石术患者术后导尿管相关膀胱刺激征的影响

Clinical effect of low-dose esketamine on catheter-related bladder discomfort after ureteroscopic lithotripsy in elderly male patients

摘要:

目的 探讨小剂量艾司氯胺酮对老年男性经输尿管镜碎石术（URL）患者术后导尿管相关膀胱刺激征（CRBD）的影响。方法 选取2023年10月－2024年6月于该院择期行URL的老年男性患者90例，随机将患者分为A组（艾司氯胺酮组）和B组（对照组），各45例。全麻诱导后，A组（艾司氯胺酮组）和B组（对照组）分别静脉缓慢注射艾司氯胺酮0.15 mg/kg（用生理盐水稀释至10 mL）和等体积生理盐水。观察记录患者T₀（拔管即刻）、T₁（拔管后30 min）、T₂（拔管后2 h）和T₃（拔管后6 h）时点CRBD的发生率及严重程度；通过简易精神状态检查（MMSE）评分，于术前1 d和术后6 h评估患者的神经认知情况和围手术期神经认知紊乱（PND）发生率；记录两组患者围手术期和麻醉恢复室（PACU）观察期的相关指标。结果 两组患者麻醉时间、苏醒时间、丙泊酚和瑞芬太尼用量比较，差异均无统计学意义（P > 0.05）；A组T₀、T₁、T₂和T₃时点的CRBD发生率明显低于B组，A组T₀和T₁时点CRBD严重率明显低于B组，差异均有统计学意义（P < 0.05）；A组术后6 h的MMSE评分明显高于B组，PND发生率明显低于B组，差异均有统计学意义（P < 0.05）；A组T₀时点需追加盐酸曲马多例数明显少于B组，Ramsay镇静评分（RASS）明显高于B组，视觉模拟评分法（VAS）评分和Ricker镇静-躁动评分（SAS）明显低于B组，差异均有统计学意义（P < 0.05）；两组患者术后均未出现不良反应。结论 小剂量艾司氯胺酮可以有效地降低老年男性URL患者术后早期CRBD的发生率，并缓解其严重程度，可能与其对术后认知功能影响小和镇静镇痛的效果较好有关。

Abstract:

Objective To investigate the effects of low-dose esketamine on catheter-related bladder discomfort (CRBD) in elderly male patients after ureteroscopic lithotripsy (URL).Methods 90 elderly male patients with URL from October 2023 to Jun 2024 were selected and randomly divided into group A (esketamine group) and group B (control group), 45 cases in each. After induction of general anesthesia, group A received intravenous infusion of 0.15 mg/kg esketamine hydrochloride diluted with saline to 10 mL, while group B received an equal volume of saline. The occurrence and severity of CRBD were recorded at T₀ (immediately after catheter removal), T₁ (30 min after catheter removal), T₂ (2 h after catheter removal), and T₃ (6 h after catheter removal) time points. The neurocognitive status and the incidence of perioperative neurocognitive disorder (PND) were assessed using the mini-mental state examination (MMSE) score one day before surgery and 6 h after surgery. Relevant indicators during the perioperative period and in the postanesthesia care unit (PACU) observation period were recorded for both groups.Results There were no statistically significant differences in anesthesia duration, recovery time, dosages of propofol and remifentanil between the two groups (P > 0.05). Compared with group B, group A showed significantly lower CRBD incidence rate at T₀, T₁, T₂ and T₃ time points, and the severity rate of CRBD at T₀, and T₁ time points in group A was significantly lower than that in group B, the differences were statistically significant (P < 0.05). Group A also had higher MMSE scores and lower PND incidence rate 6 h after surgery compared to group B, the differences were statistically significant (P < 0.05). Compared with group B, group A required fewer tramadol hydrochloride administrations at T₀, exhibited higher Ramsay sedation scale (RASS) scores, and lower Visual analog the scale (VAS) scores and Richer agitation-sedation Scale (SAS) scores, the differences were statistically significant (P < 0.05). No adverse reactions were observed in either group after surgery.Conclusion Low-dose esketamine can effectively reduce the incidence and severity of early CRBD in elderly male patients after URL, which may be related to its minimal impact on postoperative cognitive function and better sedative and analgesic effects.