右美托咪定联合舒芬太尼对输尿管镜下钬激光碎石术患者全身麻醉苏醒期躁动和膀胱刺激症的影响

Effect of dexmedetomidine plus sufentanil on agitation and bladder irritation in general anesthesia in patients with ureteroscopic holmium laser lithotripsy

目的探究右美托咪定联合舒芬太尼对输尿管镜下钬激光碎石术患者全身麻醉苏醒期躁动和膀胱刺激症的影响。方法选取2020年1月至2022年12月在蚌埠医学院附属合肥市第二人民医院进行输尿管镜下钬激光碎石术的患者96例纳入前瞻性研究,按照随机数字表法将其分为对照组和研究组,每组各48例。对照组采用常规气管插管全身麻醉,研究组采用右美托咪定联合舒芬太尼复合麻醉。记录并比较两组患者临床指标[手术时间、补液量、体温、麻醉后恢复室(PACU)停留时间]、苏醒时间、术中体动次数、不同时间点[气管插管前(T_(0)),气管插管即刻(T_(1)),拔管时(T_(2)),拔管后10 min(T_(3))]Ramsay镇静评分、不同时间点(苏醒后5 min、术后1 h、术后2 h、术后6、术后12 h)疼痛视觉模拟评分法(VAS)评分、不同时间点(术前、给药后、离室时)平均动脉压及心率情况、输尿管镜刺激反应及术后不良反应情况。结果两组的手术时间、补液量及睁眼时间比较,差异均无统计学意义(P>0.05);研究组患者的PACU停留时间、麻醉苏醒时间均短于对照组,术中体动次数少于对照组,差异均有统计学意义(P<0.05)。T_(0)、T_(3)时,两组间Ramsay镇静评分比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)时,两组患者的Ramsay镇静评分高于T_(0),且研究组患者的Ramsay镇静评分均高于对照组,差异均有统计学意义(P<0.05)。术后6、12 h时,两组患者的VAS评分比较,差异均无统计学意义(P>0.05),苏醒后5 min、术后1 h、术后2 h时,研究组患者的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。两组患者术前、给药后、离室时的平均动脉压组间比较,差异均无统计学意义(P>0.05);两组术前的心率比较,差异无统计学意义(P>0.05);研究组给药后及离室时的心率高于对照组,差异均有统计学意义(P<0.05)。研究组患者输尿管镜刺激反应1、2级占比高于对照组,3级占比低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生的情况比较,差异无统计学意义(P>0.05)。结论右美托咪定联合舒芬太尼可缩短输尿管镜下钬激光碎石术患者麻醉诱导及苏醒时间,提高患者的镇静效果,改善输尿管镜刺激反应,且不会提高患者的不良反应的发生率,具有较高的临床应用价值。

Objective To explore the effects of dexmedetomidine and sufentanil on agitation and bladder irritation in general anesthesia in patients with ureteroscopic holmium laser lithotripsy.Methods A total of 96 patients undergoing ureteroscopic holmium laser lithotripsy in The Second People's Hospital of Hefei from January 2020 to December 2022 were included in the study.According to the random number table method,they were divided into a control group and a study group,with 48 cases in each group.The control group received conventional tracheal intubation general anesthesia,while the study group received dexmedetomidine combined with sufentanil combined anesthesia.Clinical indicators of two groups of patients[surgical time,fluid replacement volume,body temperature,post anesthesia recovery room(PACU)stay time],awakening time,intraoperative body movements,Ramsay sedation score at different time points[before tracheal intubation(T_(0)),immediately after tracheal intubation(T_(1)),at extubation(T_(2)),10 minutes after extubation(T_(3))],pain visual analog scoring method(VAS)at different time points(5 minutes after awakening,1 hour after surgery,2 hours after surgery,6 hours after surgery,12 hours after surgery),the average arterial pressure and heart rate at different time points(before surgery,after administration,and at room departure),ureteroscopic stimulation response,and postoperative adverse reactions were recorded and compared.Results There were no statistically significant differences in the surgical time,fluid replacement volume,and eye opening time between the two groups(P>0.05);the PACU retention time and anesthesia recovery time of the study group patients were shorter than those of the control group,and the number of intraoperative body movements was less than that of the control group,the differences were statistically significant(P<0.05).At T_(0) and T_(3),there were no statistically significant differences in Ramsay sedation scores between the two groups(P>0.05);at T_(1) and T_(2),the Ramsay sedation scores of the two groups of patients were higher than at T_(0),and the Ramsay sedation scores of the study group were higher than those of the control group,the differences were statistically significant(P<0.05).At 6 and 12 hours after surgery,there were no statistically significant differences in VAS scores between the two groups(P>0.05);at 5 minutes after awakening,1 hour after surgery,and 2 hours after surgery,the VAS scores of the study group were lower than those of the control group,the differences were statistically significant(P<0.05).There were no statistically significant differences in the mean arterial pressure between the two groups before surgery,after medication administration,and at room departure(P>0.05).There was no statistically significant difference in preoperative heart rate between the two groups(P>0.05);the heart rate of the study group after administration and at room departure were higher than those of the control group,the differences were statistically significant(P<0.05).The proportion of grade 1 and 2 receiving ureteroscopy stimulation response in the study group was higher than that in the control group,while the proportion of grade 3 was lower than that in the control group,the difference was statistically significant(P<0.05).There was no statistical significant difference in the occurrence of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine combined with sufentanil can shorten the anesthesia induction and awakening time of patients with holmium laser lithotripsy,improve the sedation effect of patients,improve the response of ureteroscopic stimulation,and will not increase the incidence of adverse reactions in patients,which has a high clinical application value.