陈伟 冯艳

摘 要 目的：探讨右美托咪定在腰麻硬膜外联合麻醉下经皮肾镜取石术中的应用效果。方法：将90例接受经皮肾镜取石术的患者随机分为对照组和观察组各45例，两组均采用腰麻硬膜外联合麻醉，对照组术中给予生理盐水，观察组给予右美托咪定，监测手术不同时间点的血流动力学参数，术后24 h分别用视觉模拟评分（VAS）评定疼痛程度，用Ramsay镇静评分评定镇静深度，比较两组神经阻滞时间和术后麻醉恢复时间。结果：观察组多时点血流动力学参数、VAS评分和不良反应发生率明显低于对照组，Ramsay评分则高于对照组，神经阻滞时间和麻醉恢复时间较对照组明显延长。结论：右美托咪定用于腰硬联合麻醉下经皮肾镜取石术患者，可有效增强镇痛、镇静效果，维持术中血流动力学稳定性，可减少麻醉相关并发症的发生。

关键词 右美托咪定 腰硬联合麻醉 经皮肾镜取石术

中图分类号：R614.27； R692.4 文献标志码：B 文章编号：1006-1533（2019）01-0024-03

Effect of dexmedetomidine on 45 patients undergoing percutaneous nephroscopic surgery under combined spinal-epidural anesthesia

CHEN Wei， FENG Yan*

（Department of Anesthesiology， the Peoples Hospital of Kaizhou District， Chongqing 405400， China）

ABSTRACT Objective： To investigate the effect of dexmedetomidine in percutaneous nephrolithotomy under combined spinal and epidural anesthesia. Methods： Ninety patients undergoing percutaneous nephrolithotomy were randomly divided into a control group and an observation group with 45 cases each. Both groups were given combined spinal and epidural anesthesia. Besides， saline was given in the control group while dexmedetomidine in the observation group during the operation. Hemodynamic parameters at different time points were monitored. The degree of pain and the degree of sedation were evaluated 24 hours after operation by visual analogue scale （VAS） and Ramsay sedation score， respectively. The time for the nerve blocking and the recovery of anesthesia was compared between the two groups. Results： The multi-time hemodynamic parameters， the VAS score and the incidence of adverse reactions were significantly lower， the Ramsay score was higher and the time for the nerve blocking and the recovery of anesthesia was significantly longer in the observation group than the control group. Conclusion： Dexmedetomidine for the patients undergoing percutaneous nephrolithotomy under combined spinal and epidural anesthesia can effectively improve the analgesic and sedative effects， maintain the stability of intraoperative hemodynamics and reduce the incidence of anesthesia-related complications.

KEy WORDS dexmedetomidine； combined spinal epidural anesthesia； percutaneous nephrolithotomy

經皮肾镜取石术是泌尿外科的一项重要手术，由于创伤小、住院时间短、术后并发症少，在临床应用中具有明显的优势。经皮肾镜取石术的患者采用腰硬联合麻醉，可快速达到令人满意的镇痛作用。但是，由于大多数患者在手术过程中会遇到巨大的心理问题，此类压力可能引起患者的恐惧、焦虑、易怒等多种情绪反应，会对手术和麻醉产生不利影响。因此，手术过程中，对患者采取适当的镇静措施是很有必要的[1]。在我院，右美托咪定被用于腰硬联合麻醉下行经皮肾镜取石术的患者，并观察其对患者的影响。……