超声引导下椎旁神经阻滞复合右美托咪定持续泵注与单纯全麻用于老年患者经皮肾镜手术的效果比较  

Comparison of Ultrasound-guided Paravertebral Nerve Block Combined with Continuous Pumping of Dexmedetomidine and Simple General Anesthesia for Percutaneous Nephroscopy in Elderly Patients

作　　者：张剑 王兴耀 王定伦 江波 ZHANG Jian;WANG Xing-yao;WANG Ding-lun;JIANG Bo(Department of Anesthesiology,Xuanwei Traditional Chinese Medicine Hospital,Xuanwei,Yunnan Province,655400 China)

机构地区：[1]云南省宣威市中医医院麻醉科,云南宣威655400

出　　处：《中外医疗》2021年第8期28-31,35,共5页China & Foreign Medical Treatment

摘　　要：目的探讨超声引导下椎旁神经阻滞复合右美托咪定持续泵注应用于经皮肾镜手术中的安全性及麻醉效果。方法方便选择云南中医药大学附属宣威市中医医院2018年2月—2019年6月择期经皮肾镜手术的老年患者70例,随机分为超声引导下的椎旁神经阻滞复合右美托咪定持续泵注组(A组,n=35)和单纯全麻手术组(B组,n=35)两组。记录患者进入手术室后(T0)、手术切皮时(T1)、手术结束时(T2)、术后2 h(T3)、术后6 h(T4)、术后12 h(T5)、术后24 h(T6)的平均动脉压(MAP)、心率(HR)、呼吸频率(R)和脱氧5 min的SpO_(2)的数值;记录手术后2 h(T3)、6 h(T4)、12 h(T5)、24 h(T6)时视觉模拟疼痛评分(VAS)、PCIA按压的总次数以及恶心、呕吐、皮肤瘙痒、尿潴留的发生情况;记录患者术后2 h咽喉痛、咳嗽咳痰的情况;记录患者麻醉费用、手术时间、总住院费用、手术医生和患者满意度情况。结果在T1、T2、T3、T4、T5、T6时间点A组比B组的MAP低,差异有统计学意义(t=3.012、3.386、3.125、3.178、3.214、3.307,P<0.05);在T1、T2、T3、T4、T5、T6时间点A组比B组的HR低,差异有统计学意义(t=2.282、2.346、2.425、2.218、2.695、2.013,P<0.05);T3、T4、T5、T6,A组VAS评分比B组低,差异有统计学意义(t=10.183、9.763、9.872、8.095,P<0.05);A组术后恶心发生率和呕吐发生率分别为37.14%和14.28%,明显低于B组的57.14%和28.57%,差异有统计学意义(χ^(2)=8.173、9.532,P<0.05);术后镇痛泵按压次数比较,A组比B组次数更少,差异有统计学意义(t=18.421,P<0.05);A组术后2 h咽喉痛和咳嗽咳痰分别为2.86%和8.57%,明显低于B组的11.43%和37.57%,差异有统计学意义(P<0.05);患者在手术室时间、麻醉费用、住院费用A组比B组低,差异有统计学意义(t=7.211、13.230、2.695,P<0.05);A组手术医生和患者满意度比B组高,差异有统计学意义(χ^(2)=5.140、5.840,P<0.05)。结论超声引导下的PVB复合右美托咪定持续泵注用于Objective To explore the safety and anesthesia effect of ultrasound-guided paravertebral nerve block combined with continuous pumping of dexmedetomidine in percutaneous nephroscope surgery.Methods Conveniently selected a total of 70 elderly patients undergoing elective percutaneous nephroscopy from February 2018 to June 2019 in Xuanwei Hospital of Traditional Chinese Medicine,affiliated to Yunnan University of Traditional Chinese Medicine,they were randomly divided into two groups:the ultrasound-guided paravertebral nerve block combined with dexmedetomidine continuous pump injection group(group A,n=35)and the simple general anesthesia group(group B,n=35).Record after the patient enters the operating room(T0),at the time of surgical incision(T1),at the end of the operation(T2),2 h after the operation(T3),6 h after the operation(T4),12 h after the operation(T5),and 24 h after the operation(T6),mean arterial pressure(MAP),heart rate(HR),respiratory rate(R),and SpO_(2) values of 5 min after deoxygenation;Record 2 h(T3),6 h(T4),12 h(T5),24 h(T6)after surgery,Visual Analog Pain Score(VAS),the total number of PCIA compressions,and the occurrence of nausea,vomiting,skin itching,and urinary retention;Record the patient's sore throat,cough and sputum 2 h after surgery;Record the patient's anesthesia expenses,operation time,total hospitalization expenses,surgery doctor and patient satisfaction.Results At T1,T2,T3,T4,T5,T6,the MAP of group A was lower than that of group B,and the difference was statistically significant(t=3.012,3.386,3.125,3.178,3.214,3.307,P<0.05);At T1,T2,T3,T4,T5,T6,the HR of group A was lower than that of group B,and the difference was statistically significant(t=2.282,2.346,2.425,2.218,2.695,2.013,P<0.05);T3,T4,T5,T6,the VAS score of group A was lower than that of group B,and the difference was statistically significant(t=10.183,9.763,9.872,8.095,P<0.05);The incidence of postoperative nausea in group A and the incidence of vomiting were 37.14%and 14.28%,respectively,which were significantly lower than t

关 键 词：超声引导 椎旁神经阻滞 右美托咪定 全麻 老年患者 经皮肾镜 

分 类 号：R4[医药卫生—临床医学]