靳永强+赵年章++叶少方+朱咏仪

[摘要]目的 探討右旋美托咪定用于椎管内麻醉下经皮肾穿刺碎石术的效果。方法 选取我院在2014年1月～2016年11月收治的100例择期经皮肾穿刺取石术患者作为研究对象，按照单盲随机分组法随机将患者分为两组，各50例。所有患者术中麻醉方式均为椎管内麻醉，对照组术中静脉泵注生理盐水直至手术结束，观察组术中静脉泵注右旋美托咪定直至手术结束，比较两组术中生命体征、术后麻醉恢复期情况以及不良反应发生情况。结果 与对照组比较，观察组患者注药后30 min、手术结束时的血压、体温、心率均明显更高（P<0.05），两组患者在注药后10 min时的血压、体温、心率比较差异无统计学意义（P>0.05）；两组患者的术后意识恢复时间比较差异无统计学意义（P>0.05），但观察组患者麻醉恢复期的镇静评分、镇痛评分、躁动评分均明显优于对照组（P<0.05）；观察组的术中不良反应发生率明显低于对照组（P<0.05）。结论 在椎管内麻醉下经皮肾穿刺取石术中采用右旋美托咪定辅助麻醉可有效稳定患者术中生命体征，减少术中不良反应，还可有效维持患者术后麻醉恢复期镇静，且不会对术后苏醒造成干扰。

[关键词]经皮肾穿刺取石术；椎管内麻醉；右旋美托咪定

[中图分类号] R692.4 [文献标识码] A [文章编号] 1674-4721（2017）04（b）-0125-03

Effect evaluation of Dexmedetomidine in percutaneous nephrolithotomy under spinal anesthesia

JIN Yong-qiang ZHAO Nian-zhang YE Shao-fang ZHU Yong-yi

Department of Anesthesiology，the Fifth Affiliated Hospital of Guangzhou Medical University in Guangdong Province，Guangzhou 510700，China

[Abstract]Objective To study the effect of Dexmedetomidine in percutaneous nephrolithotomy under spinal anesthesia.Methods 100 patient scheduled for percutaneous nephrolithotomy in the hospital from January 2014 to November 2016 were selected as the research object，according to the single blind random method，the patients were randomly divided into two group，each group had 50 cases.Anesthesia method of all patients was spinal anesthesia，the control group received intravenous infusion of physiological saline until the end of surgery，and the observation group received intravenous injection of Dexmedetomidine until the end of surgery.The vital signs，the condition of recovery period for anesthesia and the incidence of adverse reactions were compared between two groups.Results Compared with control group，after injection for 30 minutes and at the end of the operation，blood pressure，body temperature and heart rate in the observation group were significantly higher （P<0.05），the blood pressure，body temperature and heart rate after injection for 10 minutes in two groups had no significant difference （P>0.05）；there was no significant difference in postoperative recovery time between two groups （P>0.05），but the sedation score，analgesic score and agitation score in the observation group were significantly better than those of the control group （P<0.05）.The incidence rate of adverse reactions in the observation group was significantly lower than that in the control group （P<0.05）.Conclusion In spinal anesthesia，percutaneous nephrolithotomy using Dexmedetomidine assisted anesthesia can be effective in patients with stable vital signs，reduce the adverse reactions during the operation，but also can effectively maintain the sedation at postoperative anesthesia recovery period，and postoperative recovery will not be caused interference.

[Key words]Percutaneous nephrolithotomy；Spinal anesthesia；Dexmedetomidine

经皮肾穿刺取石术（percutaneous nephrolithotomy，PCNL）是一种微创取石手术，在泌尿系统结石的治疗中逐渐得到广泛应用，其定位准确，对患者机体造成的创伤较小[1-2]。椎管内麻醉是PCNL中常用的麻醉方式，其麻醉效果显著，但在手术中患者容易出现低血压、寒战等不良反应，对手术的顺利完成造成不利影响[3]。右旋美托咪定属于常用辅助麻醉药物，本研究为探讨右旋美托咪定用于椎管内麻醉下经皮肾穿刺碎石术的效果，选取100例择期PCNL患者分别采取生理盐水、右旋美托咪定进行辅助麻醉，并比较其麻醉效果及不良反应，现报道如下。