不同麻醉方式下右美托咪定对患者尿量及电解质的影响

Effects of dexmedetomidine on urine volume and electrolytes in patients with different anesthesia approaches

目的观察右美托咪定对不同麻醉方式下患者尿量及电解质的影响。方法选取2015年1月至2016年10月在我院拟行脊髓栓系松解术者30例(A组)、下肢畸形矫正外固定器固定术者30例(B组)、微创枕大池重建术30例(C组)。A组采用局麻;B组采用腰硬联合麻醉;C组采用全麻。每组输注右美托咪定0.8μg/(kg·10 min),随后以0.4μg/(kg·h)持续输注直至手术结束。记录患者注药后每小时尿量,并于注药后不同时段监测Na^+、K^+、Ca^(2+)浓度,同时行尿常规监测尿比重。结果 A组与B组组间及组内比较各时段尿量差异无统计学意义(P>0.05)。C组在注药后2 h、3 h时尿量明显多于1 h时尿量(P<0.05),但两者差异无统计学意义,尿量在2 h时达峰值。C组在注药后1 h时与A组、B组尿量差异无统计学意义(P>0.05);注药后2 h、3 h时尿量明显多于A组、B组尿量(P<0.05)。3组各时点K^+、Na^+、Ca^(2+)浓度及尿比重有所波动,但都在正常范围内。结论右美托咪0.8μg/kg可增加全麻患者尿量,但不增加非全麻患者尿量,且不影响患者体内的电解质及尿比重。

Objective To observe the effects of dexmedetomidine on urine volume and electrolytes in patients under different anesthesia. Methods Patients were divided into lysis of tethered cord with local anesthesia（group A）; external fixator for correction of lower limb deformity with combined spinal epidural anesthesia（group B）; minimally invasive reconstruction of the cistema magna with general anesthesia（group C）. There were 30 cases in each group. All the patients were infused with dexmedetomidine 0.8 g/kg, （10min） followed by 0.4 g/（kg·h） infusion until the end of surgery. The hourly urine volume was recorded, and the Na＋, K＋ and Ca〉 concentrations were monitored at different times after the injection. Routine urinalysis was also used to monitor urinary gravity. Results There was no significant difference between the group A and the group B in the urine volume at each time points（P 〉 0.05）. In group C, the urine volume of the second, third hours were significantly higher than that of the first hour （P 〈 0.05）. The urine volume was not significantly different between the second and the third hour, and the urine volume reached the peak at the second hour. Urine volume in group C was significantly higher than that of group A and B （P 〈 0.05）. There was no significant difference in concentration of K＋ ,Na＋ ,Ca^2＋ and urine specific gravity in each group（P 〉 0.05）. Conclusion Dexmedetomidine 0.8 g/kg can increase the amount of urine in patients with general anesthesia, but do not increase the amount of urine in patients with non general anesthesia. There are no effects on the electrolyte and urine specific gravity.