右美托咪定在经皮肾镜碎石清石术中应用的临床观察﹡

摘要

Objective To explore the effects of dexmedetomidine on the hemodynamic changes and stress hormones in patients during percutaneous nephrolithotripsy .Methods A total of 50 patients who were scheduled to undergo percu-taneous nephrolithotripsy were randomly divided into an experiment group and a control group (n=25).Then, 15 min before general anesthesia, the experiment group was pumped with 1μg/kg dexmedetomidine followed by 0.4μg/(kg· h) dexmedetomidine , which was withdrawn 30 min before the end of surgery .The control group was administrated with equal amounts of normal saline .Anesthesia was induced with 2.0 mg/kg propofol, 0.2 mg/kg cisatracurium and 0.5 μg/kg sufentanil in both groups .During surgery , all patients were continuously monitored for systolic blood pressure ( SBP ) , diastolic blood pressure (DBP), heart rate (HR), and pulse oxygen saturation (SpO2).T heir SBP, DBP and HR were recorded before induction ( T0 ) , after tracheal intubation ( T1 ) , at the beginning of pneumopetritoneum ( T2 ) , tracheal extubation ( T3 ) and 10 min after extubation ( T4 ) .Results No significant difference was found in operation time be-tween two groups (P>0.05),compared with the control.The treatment group presented remarkable decreases in SBP , DBP and HR at T1 -T4(P<0.05).Significant increases were also seen as to the levels of Cor , serum epinephrine and norepinephrine (P<0.05).Conclusion Dexmedetomidine can inhibit the stress during perioperative period , resulting in more stable hemodynamic data in patients .%目的：探讨右美托咪定在俯卧位经皮肾镜碎石清石术中对患者血流动力学变化及应激激素的影响。方法择期俯卧位行经皮肾镜碎石清石手术的患者50例，随机分为实验组和对照组，每组25例。患者入室后，全麻诱导前15 min实验组泵入右美托咪定1μg／kg，续以0．4μg／（kg· h）泵入，手术结束前30 min停药。对照组给予等容积的生理盐水，2组患者麻醉诱导均采用舒芬太尼0．5μg／kg、丙泊酚2 mg／kg、顺式阿曲库铵0．2 mg／kg。2组患者术中连续监测收缩压（ SBP）、舒张压（ DBP）、心率（ HR）、脉搏氧饱和度（ SpO2）。观察2组在开始诱导泵入右美托咪定前（T0）、气管插管即刻（T1）、术中摆放俯卧位翻身时（T2）、拔气管导管时（T3）、拔管后10 min（T4），各时点的SBP、DBP、HR。并抽取各时点静脉血，测定血浆皮质醇（Cor）、肾上腺素和去甲肾上腺素的水平。结果2组患者一般情况，手术时间差异均无统计学意义（P＞0．05）。与对照组比较， T1～T4时刻实验组SBP、DBP、HR明显下降（P＜0．05），Cor、肾上腺素、去甲肾上腺素均明显降低（P＜0．05）。结论右美托咪定可以有效抑制围术期应激反应，使患者围术期血流动力学更加稳定。