右美托咪定对经皮肾镜碎石术患者术后躁动的影响

Effect of dexmedetomidine on the postoperative agitation in patients undergoing percutaneous nephrolithotomy

目的探讨右美托咪定对经皮肾镜碎石术(PCNL)患者术后躁动的影响。方法选取择期行全麻下PCNL的患者40例为观察对象,随机分为右美托咪定组和对照组,每组20例。右美托咪定组于麻醉诱导气管插管后持续静脉泵注右美托咪定0. 7μg/kg(容量20 m L),60 min泵完;对照组于麻醉诱导气管插管后持续静脉泵注20 m L的生理盐水,60 min泵完。分别记录两组患者入室时(T0)、手术开始时(T1)、手术开始后15 min(T2)、手术开始后30 min(T3)、复苏后气管导管拔出时(T4)、拔管后15 min(T5)各时间点的收缩压、舒张压、心率及T4、T5时Ramsay镇静分级和在恢复室期间的躁动评分,并记录两组寒战的发生率。结果两组心率、收缩压、舒张压比较,差异均无统计学意义(P> 0. 05);两组心率、收缩压、舒张压均有随时间变化的趋势(P <0. 05),分组与时间无交互效应(P> 0. 05)。两组手术时间、PACU滞留时间、入PACU至拔管时间及自主呼吸时间比较,差异均无统计学意义(P> 0. 05)。在恢复室期间,对照组躁动发生率为45. 00%(9/20),高于右美托咪定组的15. 00(3/20),两组比较,差异有统计学意义(P <0. 05)。对照组寒战率为40. 00%(8/20),高于右美托咪定组的5. 00%(1/20),两组比较,差异有统计学意义(P <0. 05)。结论术中静脉泵注右美托咪定能减少复苏时期躁动及寒战的发生率。

Objective To explore the effect of dexmedetomidine on postoperative agitation in the patients undergoing percutaneous nephrolithotomy（PCNL）. Methods Forty patients receiving selective PCNL under general anesthesia were enrolled as objects. The patients were randomly divided into dexmedetomidine group and control group,with 20 patients in each group. After anesthesia induction and endotracheal intubation,continuous intravenous infusion of dexmedetomidine 0. 7 μg/kg（the volume was20 m L） and normal saline were conducted in the dexmedetomidine group and the control group respectively.And the pump infusion was finished within 60 minutes. In both groups,the systolic pressure,diastolic blood pressure and heart rate were recorded when entering the room（T0）,at the beginning of operation（T1）,at15 minutes after operation（T2）,at 30 minutes after operation（T3）,when tracheal tube removal after recovery（T4） and at 15 minutes after tracheal tube removal（T5）. And Ramsay sedation grade at T4 and T5,agitation score in the recovery room and the incidence rate of shivering were also recorded in both groups.Results There were no significant differences in the heart rate,systolic pressure and diastolic pressure between the two groups（P〉0. 05）. The heart rate,systolic pressure and diastolic pressure in both groups changed over time（P〈0. 05）. No interaction was found between grouping and time（P〈0. 05）. There were no significant differences in the operative duration,PACU stay, duration between entering PACU and extubation and duration for autonomous respiration recovery between the two groups（P〉0. 05）. During the stay in recovery room,the incident rate of agitation in the control group was higher than that in the dexmedetomidine group[45. 00%（9/20） vs. 15. 00（3/20）,P〈0. 05]. The incident rate of shivering in the control group was higher than that in the dexmedetomidine group[40. 00%（8/20） vs. 5. 00%（1/20）,P〈0. 05]. Conclusion Intravenous infusion of dexmedetomidine during operation can reduce the incidence of agitation and shivering during recovery.