右美托咪定在肾衰竭患者继发性甲状旁腺功能亢进手术治疗全身麻醉中的应用  

Application of Dexmedetomidine in General Anesthesia for Surgical Treatment of Secondary Hyperparathyroidism in Patients with Renal Failure

作　　者：刘文超 LIU Wenchao(Department of Anesthesiology,Chaoyang Second Hospital(Chaoyang Maternity and Infant Hospital),Chaoyang,Liaoning 122000,China)

机构地区：[1]朝阳市第二医院(朝阳市妇婴医院)麻醉科,辽宁朝阳122000

出　　处：《中国医药指南》2025年第8期91-94,共4页Guide of China Medicine

摘　　要：目的 研究将右美托咪定应用在肾衰竭继发性甲状旁腺功能亢进手术患者全身麻醉中的作用。方法 选取2024年1月至2024年8月到朝阳市第二医院麻醉科接受治疗的108例肾衰竭继发甲状旁腺功能亢进手术患者,采用随机数字表法分为观察组和对照组,均54例。所有患者均在气管插管全身麻醉之下通过甲状旁腺全切联合自体移植术治疗,对照组全麻诱导前泵注0.9%氯化钠溶液,随后予咪达唑仑、舒芬太尼、顺式阿曲库铵及依托咪酯组合麻醉,观察组则在麻醉诱导之前15 min内静脉泵注右美托咪定1.0μg/kg,然后将右美托米啶以0.2μg/(kg·h)的速度泵注的手术结束之前的0.5 h,对比两组T1、T2、T3的血流动力学指标、麻醉优良率、麻醉恢复指标、不良反应发生率等。结果 T0时两组的心率和平均动脉压对比,差异无统计学意义(P> 0.05),T1、T2时,观察组的心率和平均动脉压相比对照组更稳定(P <0.05)。观察组的麻醉优良率高于对照组(P <0.05)。观察组的睁眼时间、呼吸恢复时间和拔管时间比对照组更短,但差异无统计学意义(P> 0.05)。观察组的不良反应发生率高于对照组,但差异无统计学意义(P> 0.05)。结论 将右美托米啶应用在肾衰继发性甲状旁腺功能亢进手术全身麻醉中能提升麻醉优良率,稳定患者的心率和平均动脉压,可在一定程度上恢复患者的麻醉指标,且安全性可观。Objective To assess the impact of dexmedetomidine on general anesthesia in patients undergoing surgical intervention for secondary hyperparathyroidism resulting from renal insufficiency.Methods A total of 108 individuals suffering from secondary hyperparathyroidism as a consequence of renal failure,who had surgical procedures conducted within the Anesthesiology Department of Chaoyang Second Hospital from January to August in 2024,were partitioned into an observation cohort and a control cohort by means of a random number table,comprising 54 subjects in each respective group.All subjects received standardized general anesthesia with endotracheal intubation for total parathyroidectomy with autotransplantation procedures.The control cohort received preoperative 0.9%sodium chloride solution administration followed by a multimodal anesthetic regimen comprising midazolam,sufentanil,cisatracurium,and etomidate.In contrast,the experimental cohort underwent a modified protocol featuring intravenous dexmedetomidine loading(1.0μg/kg over 15 minutes)pre-induction,followed by continuous maintenance infusion(0.2μg/kg/h)sustained until 30 minutes before surgical conclusion.Primary outcome measures included comparative analysis of three critical perioperative timepoints(T1:baseline,T2:intubation,T3:extubation)for cardiovascular stability parameters.Secondary endpoints encompassed anesthetic efficacy ratings,postoperative recovery metrics,and safety profile assessments through adverse event monitoring.Results Initial hemodynamic assessments(T0:pre-anesthesia baseline)demonstrated comparable cardiac rhythm and mean circulatory pressure between cohorts(P>0.05).Subsequent evaluation during surgical phases revealed superior hemodynamic stability in the intervention group at T1(intraoperative maintenance)and T2(emergence period),with significant reductions in cardiovascular parameter fluctuations relative to controls(P<0.05).The intervention cohort exhibited enhanced anesthetic quality scores compared to standard care recipients(P<0

关 键 词：肾衰竭 甲状旁腺 右美托米啶 功能亢进 全身麻醉 血流动力学 

分 类 号：R692.5[医药卫生—泌尿科学] R581.1[医药卫生—外科学]