右美托咪定联合咪达唑仑对经皮肾镜碎石术患者肾功能影响研究

Effect of dexmedetomidine combined with midazolam on the renal function in patients underwent percutaneous nephrolithotomy

目的探讨采用右美托咪定联合咪达唑仑对经皮肾镜碎石术(PCNL)患者肾功能的影响。方法选取2016年1—12月四川省人民医院行PCNL治疗的200例单侧或双侧肾结石患者作为研究对象,采用随机数字表法分为A组(n=100)与B组(n=100)。A组患者给予静脉咪达唑仑复合腰硬联合麻醉,B组患者采用右美托咪定联合咪达唑仑复合腰硬联合麻醉。记录两组患者麻醉前(T_0)、麻醉10 min(T_1)、俯卧位后(T_2)、俯卧位60 min(T_3)、术毕(T_4)时间点的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO_2)。采用警觉/镇静评分(OAA/S)评价镇静效果,并记录不良反应发生率。术前、术后即刻、术后3 d均留取血样,测定血尿素氮(BUN)、视黄醇结合蛋白(RBP)、胱抑素C(Cys-C),留取尿液标本以测定尿α1-微球蛋白(α1-MG)、尿转铁蛋白(Tf)、尿微量白蛋白(um Alb)水平。结果 T_1~T_2时间点,两组患者HR上升,T_3~T_4时间点降低,B组T_3、T_4时间点HR高于A组,两组比较,差异有统计学意义(P<0.05);T_1~T_4时间点两组MAP均较T_0时间点降低(P<0.05);两组不同时间点SpO_2变化比较,差异无统计学意义(P>0.05)。B组术毕评分为5分的比例高于A组,评分为2分、3分所占比例低于A组,两组比较,差异均有统计学意义(P<0.05);B组心动过缓、躁动发生率低于A组,差异有统计学意义(P<0.05);B组术后即刻及术后3 d Cys-C、RBP、α1-MG、Tf、umAlb均低于A组,差异均有统计学意义(P<0.05)。结论右美托咪定联合咪达唑仑可保护PCNL患者肾功能,维持术中血流动力学稳定,提高镇静效果,减少不良反应。

Objective To investigate the effect of dexmedetomidine combined with midazolam on the renal function in patients undergoing percutaneous nephrolithotomy（ PCNL）. Methods A retrospective study was performed on 200 cases of patients with unilateral or bilateral renal calculi undergoing PCNL from January to December 2016. Patients were randomly divided into Group A（ n = 100） and Group B（ n = 100）. Patients in Group A were given intravenous midazolam combined with spinal-epidural anesthesia,the others in Group B were given dexmedetomidine united midazolam and combined with spinal-epidural anesthesia. The heart rate（ HR）,mean arterial pressure（ MAP） and pulse oxygen saturation（ SpO2） were recorded at the time before anesthesia（ T0）,two groups of patients after anesthesia for 10 minutes（ T1）,prone position（ T2）,prone to 60 minutes（ T3）,the end of operation（ T4）. Changes of hemodynamic indexes in the two groups were monitored at different time points,the sedative effect was evaluated with the alertness/sedation score（ OAA/S）,and the incidence of adverse reactions was recorded. The blood samples were collected before operation,immediately after operation and 3 days after operation to determine levels of blood urea nitrogen（ BUN）,retinol binding protein（ RBP） and Cystatin C（ Cys-C）,in the meanwhile,urine samples were collected to determine levels of α1-microglobulin（ α1-MG）,urine transferrin（ Tf） and urine microalbumin（ um Alb）. Results HR of the two groups increased at T1-T2,reduced at T3-T4,HR of Group B at T3 and T4 were higher than those of Group A（ P 0. 05）; MAP in both groups at T1-T4 was lower than that at T0（ P〈0. 05）; there was no statistically significant difference in SpO2 changes between the two groups（ P 〉0. 05）. In Group B,the proportion of 5 points at the end of operation was higher than that in Group A,while the proportions of 2 points and 3 points were lower than those in Group A（ P〈0. 05）; the incidence of bradycardia and restlessness was lower than that in Group A（ P〈0. 05）; levels of Cys-C,RBP,α1-MG,Tf and um Alb were lower than those in Group A immediately after operation and 3 days after operation,and all the differences were statistically significant（ P〈0. 05）. Conclusion Dexmedetomidine combined with midazolam can protect the renal function in patients undergoing PCNL,maintain stable hemodynamics during operation,improve the sedative effect and reduce adverse reactions.