右美托咪定在亲属活体肾移植受体手术麻醉中的应用

Application of dexmedetomidine in anesthesia for recipients in living related renal transplantation

目的评价右美托咪定(Dex)应用于亲属活体肾移植终末期肾病(ESRD)受体手术麻醉的有效性与安全性。方法 2013年10月至2014年12月在安徽医科大学附属省立医院行亲属活体肾移植的ESRD患者40例,随机分为Dex组及对照组各20例。Dex组于麻醉诱导前给予Dex0.6μg/kg的负荷剂量,于20 min内泵注完毕,继以0.2μg/(kg·h)泵注1 h结束后随即行全身麻醉诱导;对照组泵注等量的生理盐水,两组的麻醉诱导及维持药物相同。观察并记录两组患者用药前(T0),用药后20 min(T1)以及置入喉罩前(T2)、置入喉罩后(T3)各时点的平均动脉压、心率及脑电双频指数(BIS);观察有否苏醒延迟,苏醒期躁动情况。记录术中、术后(4、8、12、24 h)尿量以及术前、术后(12、24 h)内生肌酐清除率。结果与T0比较,两组患者T2的平均动脉压、心率及BIS值均明显下降(均为P<0.05),两组间比较,Dex组心率、BIS下降更为明显(均为P<0.05),但平均动脉压无明显下降(P>0.05)。Dex组苏醒期躁动的发生率为15%(3/20),均为轻度躁动,与对照组(30%,6/20)比较明显下降(P<0.05)。Dex组术中、术后4 h及8 h尿量均较相应时间的对照组明显增多(均为P<0.05)。两组患者术后12 h及24 h内生肌酐清除率均较术前明显上升(均为P<0.01)。结论右美托咪定可降低亲属活体肾移植受体苏醒期躁动发生率,增加术后尿量,无发生苏醒延迟,可安全用于ESRD患者。

Objective To assess the effectiveness and safety of dexmedetomidine （Dex） in anesthesia for end-stage renal disease （ESRD）recipients in living related renal transplantation.Methods Forty ESRD patients undergoing living related renal transplantation in the Affiliated Provincial Hospital of Anhui Medical University from October 201 3 to December 201 4 were randomized into the Dex group and the control group,20 patients in each group.In the Dex group,the patients were pumped with the loading dose of Dex at 0.6 μg/kg before anesthesia induction and the procedure was completed within 20 min.Then,the patients were pumped at 0.2 μg/（kg·h）for 1 h and underwent general anesthesia induction.In the control group,the patients were pumped with equivalent normal saline.The anesthesia induction and the maintenance drug of the two groups were the same.The mean arterial pressure （MAP）,heart rate （HR）and bispectral index （BIS） before administration （T0 ）,20 min after administration （T1 ）,before laryngeal mask placement （T2 ）and after laryngeal mask placement （T3 ）of the two groups were observed and recorded.Delayed recovery and emergence delirium were also observed.Urine output during transplantation,4,8,1 2,24 h after transplantation,as well as endogenous creatinine clearance rate （Ccr）before transplantation and 1 2,24 h after transplantation were recorded.Results Compared with T0 ,the MAP,HR and BIS of the two groups at T2 decreased significantly （all in P 〈0.05）.As for the comparison between two groups,the HR and BIS of the Dex group decreased significantly （both in P 〈0.05 ）,but the MAP didn＇t decrease significantly （P 〉0.05 ）.The emergence delirium in the Dex group was all mild with the incidence of 1 5% （3 /20）,which significantly deceased in comparison with that in the control group （30%,6 /20）（P 〈0.05）.The urine outputs of Dex group during transplantation,and 4 h and 8 h after transplantation were significantly higher than those of the control group （all in P 〈0.05）.The Ccr of the two groups at 1 2 h and 24 h after transplantation significantly increased, compared with that before transplantation （all in P 〈0.01 ）.Conclusions Dex may reduce the incidence of emergence delirium of recipient in living related renal transplantation,increase urine output after transplantation and cause no delayed recovery,which may be used in ESRD patients safely.