超声引导下椎旁神经阻滞麻醉复合右美托咪定在经皮肾镜碎石手术中的应用

Effect of ultrasound-guided paravertebral blockade combined with dexmedetomidine in percutaneous nephrolithotomy operation

目的探讨超声引导下椎旁神经阻滞麻醉复合右美托咪定在经皮肾镜碎石术(PCNL)手术中的应用效果。方法选择2015年10月至2016年12月广州医科大学第五附属医院需择期行PCNL手术的肾结石患者150例,以随机数表法分为观察组和对照组,每组75例,观察组给予超声引导下椎旁神经阻滞复合右美托咪定麻醉,对照组给予腰硬联合麻醉,比较两组患者麻醉操作时间、阻滞起效时间与维持时间、镇痛效果、血液动力学变化及不良反应。结果观察组患者的麻醉操作时间、感觉和运动阻滞起效时间分别为(3.7±1.1)min、(3.62±3.14)min、(12.63±3.63)min,明显低于对照组的(11.2±1.3)min、(14.88±3.12)min、(18.01±3.62)min,差异均有统计学意义(P<0.05);观察组患者的感觉及运动阻滞维持时间分别为(695.95±45.75)min、(582.45±42.26)min,明显长于对照组的(487.69±45.66)min、(365.23±42.39)min,差异均有统计学意义(P<0.05);观察组患者的Ramsay评分1分者0例,明显少于对照组的34例,差异有统计学意义(P<0.05);观察组患者麻醉后45 min的平均动脉压(MAP)、心率(HR)为(69.26±3.41)mm Hg、(66.25±4.01)次/min,明显低于对照组的(87.54±6.01)mm Hg、(85.21±10.25)次/min,差异均有统计学意义(P<0.05);观察组患者的不良反应发生率为4.0%,明显低于对照组的36.0%,差异有统计学意义(P<0.05)。结论超声引导下椎旁神经阻滞麻醉复合右美托咪定在PCNL术中应用的镇痛、镇静效果理想,安全性高,不良反应少。

Objective To discuss the effects of ultrasound-guided paravertebral blockade （PVB） combined with dexmedetomidine in percutaneous nephrolithotomy （PCNL） operation. Methods A total of 150 patients with renal calculus, who underwent elective PCNL operation at the Fifth Affiliated Hospital of Guangzhou Medical University from October 2015 to December 2016, were selected and divided into the observation group （n=75） and the control group （n=75） according to random number tables. The observation group was anaesthetized with ultrasound-guided PVB combined dexmedetomidine, and the control group was anaesthetized with combined spinal epidural anesthesia. Then the anesthesia onset time and maintenance time, analgesic effect, hemodynamic changes, adverse reaction rate were con-trasted between the two groups. Results The onset time of sensory and motor block, the operation time in the observa-tion group were （3.7±1.1） min, （3.62±3.14） min, （12.63±3.63） min, respectively, which were significantly lower than cor-responding （11.2 ± 1.3） min, （14.88 ± 3.12） min, （18.01 ± 3.62） min in the control group （P〈0.05）;The sensory and motor block duration in the observation group were （695.95 ± 45.75） min and （582.45 ± 42.26） min, which were significantly longer than （487.69±45.66） min and （365.23±42.39） min in the control group （P〈0.05）;There was 0 case in the obser-vation group versus 34 cases in the control group having ramsay score of one （P〈0.05）;mean arterial pressure （MAP） and heart rate （HR） 45 min after anesthesia in the observation group were （69.26±3.41） mmHg and （66.25±4.01） times/min, respectively, which were significantly lower than （87.54±6.01） mmHg and （85.21±10.25） times/min in the control group （P〈0.05）;the incidence of benign reaction was 4.0%in the observation group versus 36.0%in the control group （P〈0.05）. Conclusion Ultrasound-guided PVB combined with dexmedetomidine has higher efficacy and safety in PCNL operation, with significant analgesic and sedative effect, and less adverse reactions.