全身麻醉期间静脉滴注右美托咪定致多尿一例并文献复习

Dexmedetomidine-induced polyuria under general anesthesia: a case report and literature review

目的引起麻醉医师们对右美托咪定导致多尿的不良反应的重视。方法回顾1例于腹腔镜双侧腹股沟直疝无张力修补术中使用右美托咪定后出现多尿的患者的临床资料,并以"右美托咪定"和"多尿"为关键词(包括中英文)在PubMed和中国期刊全文数据库(CNKI)进行检索,收集并分析检索到的使用右美托咪定后出现多尿的患者的资料。结果该例患者为28岁男性,其因发现左侧腹股沟可复性肿块而入院检查,最终被诊断为双侧腹股沟直疝,于全身麻醉下接受腹腔镜双侧腹股沟直疝无张力修补术,术中使用右美托咪定后其尿量增多,最后统计术中尿量达1600 ml,因手术时间仅1.5 h,且术中检测患者血压无明显波动,故除常规术中补液外未予其他特殊处理,术后患者情况良好并于2 d后出院。检索文献共收集到9例使用右美托咪定后出现多尿患者的资料,他们的术中尿量为1980~4500 ml。结论应用右美托咪定时麻醉医师较关注术中少尿的问题,多尿情况虽然少见,但仍应引起重视,警惕术中因多尿引起容量负平衡导致的低血压。

Objective To arouse the attention of anesthesiologists to the adverse events of dexmedetomidine-induced polyuria. Methods Clinical data of 1 case of dexmedetomidine-induced polyuria during laparoscopic tension-free repair of bilateral direct inguinal hernia were retrospectively analyzed. Literature review was performed from PubMed and CNKI using the key words of ‘dexmedetomidine’ and ‘polyuria’ in both English and Chinese. Relevant data of the patients presenting with polyuria after administration of dexmedetomidine were collected and analyzed. Results The 28-year-old male patient was admitted to our hospital due to the mass in the left inguinal region. He was eventually diagnosed with bilateral direct inguinal hernia and underwent laparoscopic tension-free repair of bilateral direct inguinal hernia under general anesthesia. He experienced polyuria after intraoperative use of dexmedetomidine with an estimated intraoperative urine volume of 1600 ml. The operation time was 1.5 h. No significant fluctuation was observed in the blood pressure during the surgery. Routine intraoperative fluid infusion was given alone. The patient was properly recovered and discharged 2 d later. After literature review, 9 cases of dexmedetomidineinduced polyuria were researched. The intraoperative urine volume was ranged from 1980 to 4500 ml. Conclusions Anesthesiologists mainly concentrate on the incidence of oliguria induced by dexmedetomidine rather than the polyuria due to the low incidence. Nevertheless, extensive attention should be diverted to the hypotension induced by negative volume balance due to intraoperative polyuria.