右美托咪定用于经皮肾镜取石术麻醉中的临床研究

Clinical study of dexmedetomidine used in anesthesia during percutaneous nephrolithotomy

目的研究经皮肾镜碎石取石术中使用右美托咪定镇静镇痛的效果。方法择期在硬膜外麻醉下行经皮肾镜碎石取石术的复杂性泌尿结石的患者60例,年龄18～60岁,ASA I-Ⅲ级,随机分为两组,每组30例:D组用右美托咪定作为麻醉镇静的辅助用药;DF组用盐酸哌替啶+氟哌利多作为麻醉镇静的辅助用药。记录患者麻醉前(T0)、用药后5 min(T1)、经尿道置入输尿管导管时(T2)、手术60 min(T3)、手术120 min(T4)、术毕(T5)的MAP、Sp02、HR、R amsay评分的变化情况,记录硬膜外腔给药的间隔时间;记录呼吸抑制的发生率、置入输尿管导管时肢动反应的发生率、术中寒战反应的发生率、外科医生对镇静效果的满意率、手术的完成率、患者对手术的回忆率。结果 T2-T4时,D组Ramsay评分高于DF组(P<0.05);T1-T4时,D组Sp02高于DF组(P<0.05);T2-T4时,D组MAP、HR低于DF组(P<0.05);D组硬膜外腔给药的间隔时间长于DF组(P<0.05);D组呼吸抑制的发生率、置入输尿管导管时肢动反应的发生率、术中寒战反应的发生率、患者对手术的回忆率低于DF组(P<0.05),D组外科医生对镇静效果的满意率、手术的完成率高于DF组(P<0.05)。结论右美托咪定在经皮肾镜取石术麻醉中镇静效果良好,能保证手术安全顺利完成。

[ Objective ] To evaluate the clinical effects of sedation and analgesia of dexmedetomidine used in anesthesia during percutaneous nephrolithotomy. [ Methods ] Sixty ASA I -III patients, age 18-60, the undergoing percutaneous nephrolithotomy by intraspinal anesthesia were studied. They were randomized into two groups： group D receiving dexmedetomidine （n =30）, while group DF receiving Dolantin＋Droperidol （n =30） as the control. Change of Spo2, HR, MAP, Ramsay scores were observed at pre-administration （T0）, received medicine after 5 min （T1）, imbedding ureteral catheter （T2）, 60 min （T3）, 120 min （T4） after administration, after operation （T5） respectively, interval time of drug into the spinal canal was recorded too. At the same time, the phenomenon of respiratory inhibition, limb dynamic response, shivers reaction were observed. When the operation was over, ask the surgeon for calming effect is satisfied. All patients were followed up 24 h postoperatively observe the recall during operation. [ ResuLts] Ramsay scores were higher in group D than group D F at T2-T4 （P 〈0.05）; SpO2 were higher in group D than group DF at T1-T4 （P 〈0.05）; MAP, HR were lower in group D than group DF at T2-T4（P 〈0.05）; interval time of drug into the spinal canal in group D was longer than group DF （P 〈0.05）; The incidence of respiratory inhibition, limb dynamic response, shivers reaction and recall were lower in group D than group DF （P 〈0.05）; The satisfaction incidence of surgeon for anesthesia was higher in group D than group DF （P 〈0.05）. [ Conclusion ] Dexmedetomidine for sedation in the spinal canal anesthesia during percutaneous nephrolithotomy is safe and effective.