汪海松 林梁 蔡东妙 徐林梅 陈振毅

[摘要] 目的 觀察右美托咪定对输尿管镜术中阴茎勃起的预防作用。方法 选择2018年5月～2019年5月我院泌尿外科择期在全麻下行输尿管镜碎石术男性患者200例，随机分为对照组（C组）和右美托咪定组（D组），每组100例。两组患者在麻醉诱导前15 min分别静脉泵注生理盐水和右美托咪定0.5μg/kg。观察两组患者入室时（T0）、麻醉诱导前（T1）、气管插管后消毒前（T2）、消毒开始后5 min（T3）、手术开始后10 min（T4）的平均动脉压（MAP）、心率（HR）、阴茎勃起的发生率及其程度以及苏醒期膀胱刺激征的发生率及严重程度。结果D组患者T1、T2、T3、T4时间点MAP及HR较T0时间点均降低，且低于C组同时间点（P<0.05）;D组在T2、T3和T4时间点阴茎勃起发生率分别为3.0%、7.0%和10.0%，明显低于C组11.0%、22.0%、37.0%，（P<0.05）;在T4时间点D组阴茎勃起1级、2级和3级发生率分别为7.0%、3.0%和0%，明显低于C组23.0%、9.0%、5.0%，（P<0.05）;术后苏醒期患者膀胱刺激征评分D组1级、2级、3级的发生率分别为12.0%、8.0%、2.0%，明显低于C组的28.0%、25.0%、21.0%（P<0.05）。结论 麻醉诱导前预先给予右美托咪定能够有效的预防输尿管镜手术中阴茎勃起的发生，减少苏醒期膀胱刺激征的发生率，提高患者的舒适度.

[关键词] 右美托咪定;预防;输尿管镜;阴茎勃起;膀胱刺激征;效果

[中图分类号] R614.2          [文献标识码] B          [文章编号] 1673-9701（2020）18-0128-03

Clinical effect of dexmedetomidine in preventing penile erection during ureteroscopy

WANG Haisong   LIN Liang   CAI Dongmiao   XU Linmei   CHEN Zhenyi

Department of Anesthesiology， the First Affiliated Hospital of Xiamen University， Xiamen   361003， China

[Abstract] Objective To observe the preventive effect of dexmedetomidine on penile erection during ureteroscopy. Methods 200 male patients with elective ureteroscopic lithotripsy under general anesthesia were selected at the urology department of the First Affiliated Hospital of Xiamen University from May 2018 to May 2019. They were randomly divided into the control group（group C） and dexmedetomidine group（Group D）， with 100 cases in each group. Two groups were given intravenous saline and dexmedetomidine 0.5 μg/kg 15 minutes before induction of anesthesia. The mean arterial pressure（MAP）， heart rate（HR）， incidence and degree of penile erection， and incidence and severity of bladder irritation during recovery at the time of admission（T0）， before induction of anesthesia（T1）， before disinfection and after endotracheal intubation（T2）， 5 minutes after the start of disinfection（T3）， 10 minutes after the start of surgery（T4） of two groups were observed. Results The MAP and HR of patients in group D at T1， T2， T3， and T4 were lower than those at T0， and lower than those at the same time in group C（P<0.05）. The incidence of penile erections in group D at T2， T3， and T4 were 3.0%， 7.0%， and 10.0%， which was significantly lower than that in Group C（11.0%， 22.0%， 37.0%， P<0.05）. At the T4 time point， the incidence of penile erection with grade 1， grade 2， and grade 3 was 7%， 3%， and 0% respectively in group D， which was significantly lower than that in group C（23.0%， 9.0%， 5.0%， P<0.05）. The incidence of bladder irritation score of grade 1， grade 2， grade 3 in the postoperative recovery period in group D was 12.0%， 8.0%， and 2.0%， which was significantly lower than that of group C（28.0%， 25.0%， 21.0%， P<0.05）. Conclusion Pre-administration of dexmedetomidine before anesthesia induction can effectively prevent the occurrence of penile erection during ureteroscopy， reduce the incidence of bladder irritation during recovery， and improve patient comfort.

[Key words] Dexmedetomidine; Prevention; Ureteroscopy; Penile erection; Bladder irritation sign; Effect

在男性泌尿外科输尿管镜手术中，由于外阴部的消毒或器械的进入，常导致阴茎异常勃起，给手术操作带来不利的影响，导致器械进入困难、出血增多、尿道损伤等，甚至最终取消手术。目前临床上常用加深麻醉、静脉给予血管活性药物、冷敷等方法进行处理，但其效果往往不理想[1]。输尿管镜手术后患者常需要导尿而导致麻醉苏醒期患者出现导尿管相关的膀胱刺激征，引起患者不适甚至躁动不安。右美托咪定是一种强效的高选择性的α2受体激动剂，具有镇静、镇痛作用，以剂量依赖的方式降低患者的血压、心率和心输出量[2]。其降低血压主要是通过抑制中枢交感神经及减少去甲肾上腺素的释放[3]。此外，右美托咪定能通过激活血管平滑肌α2受体，导致周围血管收缩[4]。……