To Investigate The Effect Of Ketorolac Tromethamine Combined With Penehyclidine On Urinary Catheter-related Bladder Irritation Sign

Objective:To investigate the preventive effect of ketorolac tromethamine combined with penehyclidine on urinary catheter-related bladder irritation（CRBD）in male patients after general anesthesia.Methods:60 male patients who were to undergo transurethral ureteroscopic lithotripsy under general anesthesia in China-Japan Union Hospital of Jilin University were randomly divided into three groups:control group（group C）with 20 cases,ketorolac group（group K）with 20 cases and ketorolac combined with penehyclidine group （group PK）with 20 cases.All patients in the three groups were given intravenous induction regimen,followed by midazolam 0.05mg/kg,cis-atracurium 0.25mg/kg,propofol 1.5mg/kg,etomidate 0.1mg/kg and sufentanil citrate 0.4ug/kg.Combined intravenous and inhalation anesthesia was used during the operation,and BIS value was controlled at 40-60.At the last stage of the operation,experienced urologists performed catheterization according to standard procedures.Patients in group C received intravenous injection of 0.01ml/kg of normal saline 15 minutes before anesthesia induction and 1 ml of normal saline 30 minutes before the end of operation.Patients in group K were given intravenous saline 0.01ml/kg 15min before anesthesia induction,and intravenous nisone（ketorolac tromethamine）30mg 30min before the end of operation.Group PK patients received intravenous injection of penehyclidine hydrochloride（penehyclidine hydrochloride）0.01mg/kg 15min before anesthesia induction,and intravenous injection of nisone 30mg 30 min before the end of operation.Record the patient’s basic information,including name,age,ASA grade,height and weight,calculate BMI,and record the patient’s operation time,anesthesia time and tracheal extubation events（from the end of operation to extubation time）;The vital signs such as heart rate,noninvasive blood pressure,respiratory rate and pulse oxygen saturation,Ramsay sedation score and agitation score,and postoperative adverse reactions（such as restlessness,nausea and vomiting,respiratory depression,dry mouth,etc.）were recorded at different time points at the time of extubation（T0）and 5 min（T1）,10min（T2）,15 min（T3）and 20 min（T4）.The occurrence and degree of CRBD were recorded immediately after extubation（T0）and 20 minutes after extubation（T4）.The data was analyzed by SPSS 25.0 software.Results:There was no significant difference in basic information and related time statistics（age,BMI,ASA grade,operation time,anesthesia time and extubation time）among the three groups（P>0.05）.The incidence and severity of CRBD in PK group immediately after extubation（T0）were significantly lower than those in K group and C group（P﹤0.05）,and the incidence of CRBD in PK group and K group at T4 （20min after extubation）was significantly lower than that in C group（P﹤0.05）.The mean arterial pressure of PK group at different time points was lower than that of C group（P<0.05）,and the mean arterial pressure at T1,T3 and T4 was lower than that of K group（P<0.05）.There was no difference in SPO₂between the three groups at T0 and T1（P>0.05）,while SPO₂in PK group was higher than that in C group at T2,T3 and T4（P<0.05）.There was no significant difference in respiratory rate and heart rate between the three groups at different time points（P>0.05）.Compared with group C,the agitation score in PK group decreased at T0 and T1（P<0.05）,and Ramsay score increased at T0,T1 and T4（P<0.05）.Compared with the other two groups of patients,the treatment rate of tramadol in PK group decreased after operation（P<0.05）.There was no significant difference in the incidence of nausea,vomiting and respiratory depression among the three groups（P>0.05）.The incidence of restlessness in PK group was significantly lower than that in other two groups（P<0.05）.The incidence of xerostomia in PK group was significantly higher than that in other two groups（P<0.05）.Conclusion:Intravenous injection of penehyclidine hydrochloride 0.01mg/kg 15min before anesthesia induction and ketorolac tromethamine 30mg 30min before the end of operation in male urology surgery can effectively prevent the occurrence of CRBD in the recovery period of general anesthesia,stabilize hemodynamics in the recovery period and reduce the occurrence of postoperative adverse reactions.