右美托咪定和咪达唑仑辅助短时腰麻下输尿管镜手术的比较

目的：比较氯普鲁卡因蛛网膜下腔阻滞下行输尿管镜手术时右美托咪定和咪达唑仑的镇静效果及不良反应。方法80例择期行输尿管镜下钬激光碎石术或支架置入术的患者随机分成右美托咪定组（D组）和咪达唑仑组（M组），以2.5%氯普鲁卡因1.6ml行蛛网膜下腔阻滞神经阻滞，麻醉效果满意后开始镇静，分别予右美托咪定1.0g/kg及咪达唑仑0.1mg/kg，观察两组麻醉前（T0）、开始镇静时（T1）、输注镇静药后5min（T2）、输尿管镜置入后5min（T3）、手术结束时（T4）生命体征变化。记录两组镇静起效时间、效果和持续时间，并观察两组不良反应发生情况。结果 T2、T3时，2组患者血压、心率及M组脉搏血氧饱和度（SpO2）均较T1时降低（P〈0.05），D组SpO2无显著变化。D组镇静起效时间短于M组（P〈0.05），镇静深度D组集中于Ⅲ级，而M组多分布于Ⅱ级及Ⅵ级，D组满意率高于M组且镇静持续时间长于M组（P〈0.05）。D组不良反应主要为术中心动过缓和术后头晕，而M组多见呼吸抑制和术后头晕，不良发生率D组（25%）低于M组（48%），（P〈0.05）。结论右美托咪定较咪达唑仑更适用于腰麻下输尿管镜手术中镇静。

Objective AIM To compare the sedative effect and adverse reaction of dexmedetomidine and midazolam in ureteroscope operation under short lumbar anesthesia with chloropro-caine. METHODS Eighty patients undergoing ureteroscope surgery for lithotripsy or bracket insertion were randomly divided into 2 groups with 40 for each. The patients in both groups were injected with 2.5%chloroprocaine 1.6mL in subarachnoid . After the satisfactory anaesthesia effect attained,the patients in dexmedetomidine group（group D） and midazolam group （group M） received dexmedetomidine 1.0g/kg（group D） and midazolam 0.1mg/kg respectively. The patients’vital signs were recorded before anaesthesia （T0）,at sedation beginning （T1）, 5min after injection of sedatives（T2）,5min after ureteroscope insertion （T3） and complete the operation （T4）. The onset time of sedation,duration of effects and the occurrence of adverse reactions were observed. Results The patients’ blood pressure,heart rate in both groups and pulse oxygen saturation（SpO2）in the group M at T2,T3 were decreased compared with those at T0（P〈0.05）. While the SpO2 in the group D showed no obvious changes. The onset time of sedation in the group D was shorter compared with that in the group M（P〈0.05）. The sedation deepness in the group D centralized at gradeⅢin the group D,while distributed by gradeⅡorⅥin the group M. The satisfaction rate in the group D was higher than that in the group M（P〈0.05）. The continued sedation time in the group D was longer than that in the group M（P〈0.05）. Intraoperative bradycardia and post-surgery depression was major adverse reactions in the group D. Dizziness and postoperative respiratory depression were mainly seen in the group M. The adverse reaction rate of group D（25%） was lower than that in the group M （48%,P〈0.05）. Conclusion Sedation with dexmedetomidine in the ureteroscope operation with lumbar anesthesia is more suitable than midazolam.