羟考酮或芬太尼联合右美托咪定在软性输尿管镜钬激光碎石术中的效果

Efficacy of oxycodone or fentanyl combined with dexmedetomidine during flexible ureteroscopic lithotripsy

目的比较羟考酮或芬太尼联合右美托咪定（dexmedetomidine，Dex）在软性输尿管镜钬激光碎石术中的效果。方法选择2014年2月-2016年2月在我院行软性输尿管镜钬激光碎石术的患者90例，采用随机数字表法分为3组（每组30例）：芬太尼（1μg/kg）复合Dex组（Ⅰ组）、羟考酮（0．05mg／kg）复合Dex组（Ⅱ组）、羟考酮（0．10mg／kg）复合Dex组（Ⅲ组）.3组患者手术开始前10min内泵注Dex1．0μg/kg，继而以0．5μg/kg-1·h-1持续静脉输注，同时3组患者分别静脉推注芬太尼1μg/kg,羟考酮0．05、羟考酮0．10mg／kg。比较3组患者术中HR和BP的变化、输尿管镜刺激反应分级和副作用发生情况。结果Ⅲ组患者软性输尿管镜经尿道、输尿管和碎石时的BP低于Ⅰ组（P〈0．05），且经尿道和输尿管时的BP低于Ⅱ组（P〈0．05）。与Ⅰ组比较，Ⅱ组和Ⅲ组患者术中刺激反应较轻（P〈0．01）。与Ⅰ组呛咳和呼吸抑制的发生率（分别为20％、16．7％）比较，Ⅱ组（分别为0、0）和Ⅲ组（分别为0、0）的发生率降低（P〈0．05）.结论羟考酮0．10mg／kg联合Dex可以减轻软性输尿管镜钬激光碎石术中的刺激反应，且副作用发生率低于芬太尼联合Dex。

Objective To compare the efficacy of oxycodone or fentanyl combined with dexmedetomidine （Dex） during flexible ureteroseopie lithotripsy. Methods Ninety patients with flexible ureteroscopic lithotripsy hospitalized at our hospital from March 2014 to March 2016 were selected and randomly divided into three groups（n=30）. Group Ⅰ ： fentanyl combined with Dex, group Ⅱ ： oxycodone combined with Dex, group Ⅲ ： oxycodone combined with Dex. 1.0 μg/kg Dex was given intravenously in every group before skin incision for 10 min, then 0.5μg/kg-1 ·h-1 Dex was continuously infused by intravenous pump. Meanwhile, 0.05 mg/kg and 0.10 mg/kg oxycodone and 1μg/kg fentanyl were administrated intravenously in three groups, respectively. The changes of heart rate, blood pressure, ureteroscopy stimulation grading and adverse events were compared in three groups during surgery. Results The blood pressure of group m is lower than that of group Ⅰ and group Ⅲ, when flexible ureteroscopy got through the urethra reter and gravel （P〈0.05）. The stimulation reaction in group Ⅱ and group Ⅲ was better than that in group Ⅰ （P〈0.01）. The ratio of cough and respiratory depression in group Ⅱ and group Ⅲ were less than that in group Ⅰ （P〈0.05）. Conclusions 0.10 mg/kg oxycodone combined with Dex can effectively decrease the irritative responses caused by flexible ureteroscopic lithotripsy and reduced fentanyl induced adverse reactions.