右美托咪定联合靶控瑞芬太尼在经尿道膀胱肿瘤电切术中的麻醉效果

Anesthetic effect of dexmedetomidine combined with remifentanil in transurethral resection of bladder tumor

目的观察右美托咪定联合靶控瑞芬太尼在经尿道膀胱肿瘤电切术中的麻醉效果。方法选取择期静脉麻醉下行经尿道膀胱肿瘤电切术患者80例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,分为右美托咪定联合瑞芬太尼组(D组)和丙泊酚联合瑞芬太尼组(P组),2组均为40例。记录表面麻醉即刻(T0)、膀胱镜通过尿道时(T1)、切除肿瘤时(T2)以及切除肿瘤后5 min时(T3)的心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO_2)、呼吸频率(RR)。记录2组患者苏醒时间、离室时间及不良反应发生率。结果 T0、T3时间点P组RR和SpO_2明显低于D组(P<0.05);T1、T2时间点P组心率和MAP明显高于D组(P<0.05);2组患者苏醒时间和离室时间差异均无统计学意义(P>0.05)。P组患者出现呼吸抑制及术后躁动的发生率高于D组,差异均有统计学意义(P<0.05)。结论右美托咪定联合靶控输注瑞芬太尼应用于经尿道膀胱肿瘤电切术安全有效。

Objective To observe the effects of anesthesia with dexmedetomidine combined with remifentanil in transurethral resection of bladder tumor. Methods Eighty patients with transurethral resection of bladder tumor and ASAⅠ ～ Ⅱ grade were selected. They were randomly assigned into dexmedetomidine combined with remifentani group（D group）and propofol combined with remifentani group（P group）in which each group had 40 patients.The two groups were recorded when surface anesthetizing（T0）,cystoscopy passing through urethra（T1）,tumor resection（T2）,5 minutes subsequence of tumor resection（T3） at heart rate（HR）,mean arterial pressure（MAP）,oxygen saturation（SpO2）and respiratory rate（RR）. Recovery time,departure time and adverse reaction of the two groups were observed separately.Results At T0 and T3,RR and SpO2 in P group were significantly lower than those in D group（P〈0.05）. At T1 and T2,heart rate and MAP in P group were significantly higher than those in D group（P〈0.05）. There was no significant difference in the departure time and recovery time between two groups（P〉0.05）. The incidences of adverse reactions（respiratory depression and postoperative restlessness）in P group were significantly higher than those in D group（P〈0.05）. Conclusion Dexmedetomidine combined with remifentanil in transurethral resection of bladder tumor is safety and effective.