右美托咪定复合七氟烷麻醉在老年经皮肾镜取石术的应用  

Application of dexmedetomidine combined with sevoflurane in elderly patients undergoing percutaneous nephrolithotomy

作　　者：林赛娟[1] 田国刚[2] 姚欢琦[1] 田毅[1] 王颖林[1] 董盛龙[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院/海南省海口市人民医院麻醉科,海口570208 [2]海南省三亚市人民医院麻醉科

出　　处：《中国医师杂志》2014年第12期1598-1601,共4页Journal of Chinese Physician

基　　金：海南省自然科学基金项目（812170）

摘　　要：目的 探讨右美托咪定复合七氟烷麻醉用于老年患者经皮肾镜取石手术的有效性和安全性.方法 择期行经皮肾镜取石手术老年患者40例,性别不限,65 ～76（71.0±6.0）岁,ASA Ⅰ～Ⅱ级.采用随机数字表法,将患者分为两组（n=20）：右美托咪定组（D组）和丙泊酚组（P组）.两组麻醉诱导相同,静脉注射芬太尼4 μg/kg,丙泊酚1.5 ～2.0 mg/kg和顺式阿曲库铵0.2 mg/kg,脑电双频指数（BIS）值达40 ～ 50时气管插管.插管后D组给予右美托咪定0.5μg/kg（4 μg/ml）缓慢静脉输注（10 min）,继以0.3 ～0.6 μg/（kg·h）维持麻醉.P组给予丙泊酚1 mg/kg缓慢静脉输注（10min）,继以3～6 mg（kg·h）维持麻醉.两组同时吸入呼气末浓度为1.3％七氟烷维持麻醉,根据手术调整右美托咪定及丙泊酚用量,使BIS值维持于40 ～ 60.持续监测并记录麻醉前（基础值）（T0）,俯卧位10 min（T1）、碎石30 min（T2）、碎石60 min（T3）、手术结束时（T4）5个时间点心率（HR）、血压（SBP、DBP）、血氧饱和度（SpO2）和呼气末二氧化碳分压（PET C02）.记录手术时间、出血量、输液量.记录麻醉停止后患者自主呼吸恢复时间、清醒时间（呼之睁眼时间）、拔管时间、术后在恢复室停留时间、术后并发症.结果 与To时比较,T1时两组SBP、DBP均明显降低（P＜0.05）,麻醉期间两组血压、血氧饱和度和呼气末二氧化碳分压差异无统计学意义（P＞0.05）.与T0时比较,D组HR于T1～T4时均明显减慢（P＜0.05）,且D组HR于T1～T4时均明显低于P组（P＜0.05）.两组患者手术时间、出血量与输液量差异无统计学意义（P＞0.05）.两组自主呼吸恢复时间及恢复室停留时间差异无统计学意义（P＞0.05）,D组清醒及拔管时间长于P组（P＜0.05）.两组恶心、呕吐、躁动发生率差异无统计学意义（P＞0.05）,D组寒颤发生率低于P组（P＜0.05）.结论 右美托咪定复合七氟烷Objective To investigate the clinical efficacy and safety of dexmedetomidine combined with sevoflurane in elderly patient undergoing percutaneous nephrolithotomy.Methods Forty ASA Ⅰ ～ Ⅱ elderly patients of both sexes,aged 65 ～ 76 （71.0 ± 6.0）yr,scheduled for elective surgery of percutaneous nephrolithotomy under general anesthesia,were randomly divided into two groups （n =20 each）：dexmedetomidine/sevoflurane group （group D） and propofol/sevoflurane group （group P）.All patients received fentanyl,propofol,and cisatracurium for anesthesia induction.After endotracheal intubation,patients in group D received an initial loading dose of 0.5 μg/kg （4 μg/ml） of dexmedetomidine over 10 min,followed by a continuous infusion of 0.3 ～ 0.6 μg/（kg · h）.Patients in group P received an initial loading dose of 1 mg/kg of propofol over 10 min,followed by a continuous infusion of 3 ～ 6 mg/（kg · h）.All patients received the inhalation of sevoflurane for maintenance.Bispectral index was used to maintain a similar level of hypnosis in both groups （40 ～ 60）.The heart rate （HR）,blood pressure （BP） [systolic blood pressure （SBP）/diastolic blood pressure （DBP）],oxygen saturation （SpO2）,end-tidal carbon dioxide partial pressure （PETCO2） at different time points before anesthesia （T0）,10 min after prone position （T1）,30 and 60 min started lithotripsy （T2-3）,and at the end of operation （T4） were recorded,respectively.The operation time,amount of blood loss,and volume of fluid infusion were recorded.Recovery time of spontaneous ventilation,awaking time （open eyes by calling）,extubation time,staying time at postanesthesia care unit （PACU）,and relevant complications were also recorded.Results Compared to the baseline value at T0,SBP and DBP were significantly decreased at T1 in both groups（P ＜0.05）,and no significant differences in the SBP,DBP,SpO2,and PETCO2 were found between two groups（P ＞ 0.05）.Compared to the baseline value at T

关 键 词：右美托咪啶/治疗应用 氟烷/治疗应用 麻醉 内窥镜检查 肾结石/外科学 

分 类 号：R614[医药卫生—麻醉学]