贵州医科大学学报

2018, v.43;No.219(12) 1430-1435

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右美托咪定用于经尿道输尿管镜钬激光碎石术辅助麻醉的效果
The Effect of Dexmedetomidine Used for Transurethral Ureteroscope Holmium Laser Lithotripsy on Anesthesia

肖玉安;王林;王远军;李宁怡;
XIAO Yuan;WANG Lin;WANG Yuanjun;LI Ningyi;Guizhou Medical University;The Affiliated Baiyun Hospital of Guizhou Medical University;

摘要(Abstract):

目的:观察右美托咪定静脉输注辅助硬膜外麻醉下经尿道输尿管镜钬激光碎石术的麻醉效果和患者的舒适满意度。方法:选择经尿道输尿管钬激光碎石治疗输尿管中下段结石的患者60例,采用随机数字表法均分为对照组(C组)和右美托咪定组(D组),两组均采用硬膜外麻醉,D组患者在麻醉稳定后持续泵注右美托咪定1μg/kg 5~10 min使患者进入浅睡眠状态、之后予0. 5μg/(kg·h)速率泵注至术毕,对照组在相同时间点持续泵注等容量的生理盐水;分别于入室时(T0)、输尿管镜置入时(T1)、加压灌洗及钬激光碎石时(T2)、输尿管支架置入时(T3)、手术结束时(T4)、术后2 h(T5)、术后24 h(T6)记录两组患者的血压(BP)及心率(HR),同时采用视觉模拟评分法(VAS)进行疼痛评分;于术后2 h及24 h进行BCS舒适度评分及满意度调查,于T0~T4时点进行Ramsay镇静评分,同时记录围手术期不良事件发生率。结果:T2和T3时点D组BP均明显低于C组(P <0. 05),T2时点D组患者HR明显低于C组(P <0. 05),T1~T5时点D组VAS评分明显低于C组(P <0. 05);术后2 h D组BCS评分明显高于C组、D组患者满意度优良率高于C组,T1~T4时点D组Ramsay评分均明显高于C组(P <0. 05);两组患者围手术期不良事件的总发生率差异无统计学意义(P> 0. 05)。结论:右美托咪定可有效维持硬膜外麻醉期间患者血流动力学稳定,改善镇静及镇痛效果,明显提高患者的舒适度及满意度。
Objective: To observe the clinical anesthetic effect of dexmetomidine in transurethral ureteroscopic holmium laser lithotripsy by intravenous infusion of dexmetomidine under epidural anesthesia and its comfort and satisfaction on patients. Methods: We collected a total of 60 patients with middle and lower ureteral calculi,undergoing transurethral ureteroscopic holmium laser lithotripsy. 60 patients were divided into dexmetomidine group( group D,n = 30) and control group( group C,n = 30) by the random number table method. Both groups received epidural anesthesia,and then Patients in group D were continuously pumped to dexmedetomidine at a rate of 1 μg/kg 5 ~ 10 min to put them into light sleep,and then pumped to the end of the surgery at a rate of 0. 5 μg/( kg·h) after the anesthesia was stabilized. Patients in group C were was continuously pumped to the same volume of saline at the same time point. Blood pressure( BP) and heart rate( HR) of the two groups were recorded at the time of admission( T0),ureteroscope placement( T1),pressure lavage and holmium laser lithotripsy( T2),ureteral stent placement( T3),end of surgery( T4),2 hours after surgery( T5) and 24 hours after surgery( T6) and visual analogue scale( VAS) was used to score pain. A BCS comfort score and satisfaction survey was performed at 2 hours after surgery and 24 hours after surgery. Ramsay score was performed at each time point of T0 ~ T4; the incidence of adverse events during the perioperative period was observed including respiratory depression,blood pressure drop,nausea and vomiting,cough and restlessness. Results: There was no statistical difference in general data between the two groups,and there was comparability between the two groups. The hemodynamic stability of group D was significantly better than that of group C( P < 0. 05). There was no significant difference in VAS scores between the two groups at T0 and T6,but the VAS pain score in Group C was significantly higher than that in group D at the remaining time points( P < 0. 05). The BCS score in group D was significantly higher than that in group C( P < 0. 01). There was no significant difference in BCS score between the two groups during 24 hours after surgery( P > 0. 05). There was no significant difference in Ramsay score between the two groups at the time of admission( P > 0. 05),but the Ramsay score of group C was significantly lower than that of group D at other time points( P < 0. 05). There was no significant difference in the total incidence of perioperative adverse events between the two groups( P > 0. 05). Conclusion: Dexmedetomidine can effectively maintain the hemodynamic stability of patients during epidural anesthesia and improve the sedative and analgesic effects,significantly improve the comfort and satisfaction of patients.

关键词(KeyWords): 右美托咪定;钬激光碎石术;血流动力学;麻醉;满意度
dexmedetomidine;holmium laser lithotripsy;hemodynamics;anesthesia;satisfaction

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅基金资助项目[黔科合LH字(2015)7396]

作者(Author): 肖玉安;王林;王远军;李宁怡;
XIAO Yuan;WANG Lin;WANG Yuanjun;LI Ningyi;Guizhou Medical University;The Affiliated Baiyun Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2018.12.013

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