超声下椎旁神经阻滞复合右美托咪定对复杂性肾结石患者围术期脑氧代谢及血流动力学的影响

Effects of ultrasound-guided paravertebral nerve block combined with dexmedetomidine on cerebral oxygen metabolism and hemodynamics in patients with complicated renal calculus during perioperative period

目的探讨超声下椎旁神经阻滞复合右美托咪定对复杂性肾结石患者围术期脑氧代谢及血流动力学的影响。方法将131例复杂性肾结石患者按随机数字表法分观察组(66例)、对照组(65例)。两组均行经皮肾镜碎石术治疗,对照组予以腰硬联合麻醉,观察组予以超声下椎旁神经阻滞复合右美托咪定麻醉。比较两组麻醉效果(阻滞起效时间、阻滞维持时间、留观时间、持续镇痛时间)、并发症发生率,不同时点脑氧代谢(脑动-静脉血氧含量差、脑氧摄取率)、血流动力学(平均动脉压、心率)。结果观察组阻滞起效时间显著短于对照组(P<0.01),阻滞维持时间、持续镇痛时间显著长于对照组(P<0.01)。出现阻滞平面后两组脑动-静脉血氧含量差、脑氧摄取率均较麻醉前显著降低(P<0.01),观察组显著低于对照组(P<0.01)。碎石时、术后30 min两组平均动脉压、心率均较麻醉前显著升高(P<0.05或0.01),观察组显著低于对照组(P<0.01)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论超声下椎旁神经阻滞复合右美托咪定麻醉效果显著,能减轻对复杂性结石患者围术期脑氧代谢、血流动力学的影响,安全性高。

Objective To investigate the effect of ultrasound-guided paravertebral nerve block combined with dexmedetomidine on cerebral oxygen metabolism and hemodynamics in patients with complicated renal calculus during perioperative period.Methods A total of 131 patients with complicated renal calculus were divided into an observation group(n=66)and a control group(n=65)according to the random number table method.All patients underwent percutaneous nephrolithotripsy.The control group was given combined spinal and epidural anesthesia,the observation group was given ultrasound-guided paravertebral nerve block combined with dexmedetomidine anesthesia.The anesthetic effect(block onset time,block maintenance time,observation time,duration of analgesia),complication rate,cerebral oxygen metabolism at different time points[the difference of oxygen content in cerebral arteriovenous blood(DajvO 2),cerebral oxygen extraction rate(CERO 2)]and hemodynamics were compared between the two groups.Results The onset time of block in the observation group was shorter than that in the control group(P<0.01),and the block maintenance time and duration of analgesia were longer than those in the control group(P<0.01).After the block surface appeared,DajvO 2 and ERO 2 in both groups decreased(P<0.01),and the test group was significantly lower than the control group(P<0.01).The mean arterial pressure(MAP)and heart rate(HR)at the time of lithotripsy and 30 minutes after surgery of the two groups were significantly higher than those before anesthesia(P<0.05 or 0.01),the observation group was significantly lower than the control group(P<0.01).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions Ultrasound-guided paravertebral nerve block combined with dexmedetomidine has significant analgesic effect,which can reduce the influence of perioperative cerebral oxygen metabolism and hemodynamics in patients with complicated renal calculus,and the safety is high.