小剂量右美托咪定在连续硬膜外麻醉经皮肾镜取石术的临床应用

Clinical application of small dose of dexmedetomidine as an adjunct to continuous epidural anesthesia in percutaneous nephrolithotomy

目的观察小剂量右美托咪定在连续硬膜外麻醉经皮肾镜取石术的镇静和镇痛效果。方法选取择期在连续硬膜外麻醉下行经皮肾镜取石术的患者90例,ASAⅠ～Ⅱ级,按随机数字表法分为小剂量(0.2μg/kg)实验组(S1组)、中剂量(0.6μg/kg)实验组(S2组)和对照组(D组),每组30例。S1组和S2组采用连续硬膜外麻醉辅助应用不同剂量的右美托咪定,对照组采用连续硬膜外麻醉辅助应用等容积的生理盐水。记录患者麻醉前(T0)、用药后5min(T1)、经尿道置入输尿管导管时(T2)、用药后30min(T3)、用药后60min(T4)、术毕(T5)的心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO2)以及镇静/警觉(OAA/S)评分变化。记录呼吸抑制发生率、置入输尿管导管时肢动反应发生率、寒战发生率、手术医生对镇静效果的满意率、患者对手术的回忆率。结果 OAA/S镇静评分显示S1组和S2组的镇静效果均显著好于D组(P<0.01),但S1组和S2组之间差异无统计学意义(P>0.05);HR和MAP的组间比较,S1组和S2组下降,且S2组的下降较S1组更明显(P<0.01),D组上升,S1组和S2组与D组的两两比较差异有统计学意义(P<0.01);D组的不良反应发生率及患者的回忆率均明显高于S1组和S2组,差异有统计学意义(P<0.01)。结论 0.2μg/kg的小剂量右美托咪定在连续硬膜外麻醉经皮肾镜取石术中的镇静和镇痛效果好,对术中生命体征影响小,临床应用效果优于0.6μg/kg的中剂量。

Objective To observe the sedative and analgesic effect of small dose of dexmedetomidine in continuous epidural anesthesia for pereutaneous nephrolithotomy. Methods 90 patients （ASA I - II ）, who would undergo percutaneous nephrolithotomy with continuous epidural anesthesia, were randomly divided into the experimental group with small dose（0.2 μg/kg）-（Group S1 ）,the experimental group with medium dose（0.6 μg/kg） （Group S2 ） and the control group （Group D）, with 30 cases in each group. Group S1 and Group Sz were given continuous epidural anesthe- sia with different doses of dexmedetomidine, while the control group were given continuous epidural anesthesia with the same volume of normal saline. Then, the changes of heart rate （HR）, arterial oxygen saturation （SpO2）, the mean arterial pressure （MAP）, and the OAA/S scores were observed and recorded before anesthesia （To）, 5 min after anesthesia （T1） ,at the time of inserting ureteral catheter （T2）, 30 min after taking medicine （T3）, 60 min after taking medicine （T4）,and after operation （Ts） respectively. At the same time, the incidence rates of respiratory inhibition, the rates of limb movement response while inserting ureteral catheter, shivers, surgeons＇ satisfaction rates upon the sedative effects and rates of the patients＇ recollection on operation were all recorded. Results OAA/S scores showed that the sedative effect of Group S1 and Group S2 was significantly better than that of Group D（ P %0.01） ,but there was no statistical significance in the difference of stative effect between Group S1 and Group S2 （ P ）0.05）. The HR and MAP of both Group S1 and Group S2 decreased,but those of Group S2 decreased more obviously. Group D had in- creased HR and MAP,which is significantly different from those of Group S1 and Group S2 （ P %0.01）. The inci- dence rate of adverse effect and patients＇ collection rate of group D were significantly higher than those of Group S] and Group S2 （ P 〈 0. 0 1 ）. Conclusion Application of samll dose （ 0. 2μg / kg ） of dexmedetomidine has favorable sedative and analgesic effect during continuous epidural anesthesia for percutaneous nephrolithotomy. It has little in fluence on the hemodynamic change in operation and has better clinical effect than the medium dose of 0.6 μg/kg.