右美托咪定预防经皮肾镜取石术患者腰硬联合阻滞麻醉后寒战的临床观察

Clinical observation of preventive effect of dexmedetomidine on shivering after combined spinal epidural anesthesia in patients undergoing percutaneous nephrolithotomy

目的 观察右美托咪定对经皮肾镜取石术患者椎管内麻醉后寒战的预防作用.方法 选择椎管内麻醉下行经皮肾镜取石的患者44例,随机平均分为右美托咪定组（D组）和对照组（C组）.麻醉平面稳定后,D组予右美托咪定：负荷剂量0.4 μg/kg,15 min泵完,以0.4μg/（kg·h）维持;C组泵注生理盐水,泵注速度及方法同D组.记录患者麻醉前（T0）、用药后5min（T1）、手术60 min（T2）、手术120 min（T3）、术毕（T4）及术后入麻醉后恢复室（PACU）即刻（T5）、30 min（T6）、60 min（T7）的MAP、SpO2、HR、体温（T）及Ramsay评分;记录寒战分级及出现时间;记录硬膜外腔给药的间隔时间.记录术中恶心呕吐、呼吸抑制及患者对手术的回忆率等情况.结果 T1～T7时,D组Ramsay评分明显高于T0时,且D组Ramsay评分明显高于C组（P ＜0.05）;T1～T5时,两组患者MAP、HR低于T0时,D组患者HR低于C组（P＜0.05）.D组患者寒战发生率明显低于C组（P＜0.01）.D组硬膜外腔给药的间隔时间较C组长,差异有统计学意义[（130.4±11.1） min vs.（103.4±8.3） min,P＜0.05];与T0比较,T3 ～ T5组患者体温均降低（P＜0.05）.D组患者对手术的回忆率低于C组（P＜0.05）.各时间点两组患者的SpO2比较差异无统计学意义（P＞0.05）.各时间点两组患者的体表温度、寒战出现的时间及术中恶心呕吐等不良反应比较差异无统计学意义（P＞0.05）.结论 术中泵注右美托咪定可安全有效地预防经皮肾镜取石术患者椎管内麻醉后寒战的发生.

Objective To observe the effect of dexmedetomidine on preventing shivering after combined spi- nal epidural anesthesia in patients undergoing percutaneous nephrolithotomy. Methods Forty-four patients scheduled for percutaneous nephrolithotomy under combined spinal epidural anesthesia were randomly divided into two groups. Group D （ n = 22） received dexmedetomidine as a preloading dose of 0. 4 μg/kg in 15 rain followed by a maintaining infusion of 0. 4 μg/（ kg - h）, while group C received normal saline infusion as the control group. The HR, MAP, SpO2 , body temperature（T） and Ramsay scores were recorded at the time point of pre-anesthesia（ TO ） , 5 min after adminis- tration （T1） , 60 min in operation（ T2 ） , 120 min in operation（ T3 ） , operation finished（ T4 ） , entry of post-anesthesia unit （PACU） （ T5 ） , 30 min in PACU （ T6 ） and 60 min in PACU （ T7 ）. The occurrence time and grades of shivering and the interval time of epidural administration were recorded. Meanwhile, the adverse reactions, such as nausea, vomitting and respiratory inhibition were observed. All patients were followed up 24 h postoperatively to observe the recall about oper- ation. Results In group D, Ramsay scores at T1 - T7 were higher than those at TO （ P 〈 0.05 ） , and there were signifi- cant differences between the two groups （P 〈 0. 05 ）. At T1 -T5, The MAP and HR were lower than those at TO in two groups, and HR in group D were lower than that in group C （ P 〈 0. 05 ）. The incidence of shivering in group D was sig- nificant lower than that of group C（ P 〈 0.01 ）. The interval time of epidural administration in group D was longer than that of group C ： （ 130.4 ± 11. 1 ） rain vs. （ 103.4 ± 8.3 ） min （ P 〈 0. 05 ）. At T3 - T5, the body temperature was lower than those at TO （ P 〈 0.05 ）. The incidence of recall about operation in group D was lower than that of group C （ P 〈 0. 05 ）. There was no significant difference in the body temperature, SpO2 , body temperature, occurrence time of shive- ring and adverse reactions between the two groups （ P 〉 0. 05 ）. Conclusion Intraoperative dexmedetomidine infusion may be effective in preventing shivering after combined spinal epidural anesthesia in patients undergoing percutaneous nephrolithotomy.