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目的探讨右美托咪定在输尿管镜气压弹道碎石术中临床应用效果。方法选择40例输尿管结石经输尿管镜气压弹道碎石的患者(ASA分级I～Ⅲ)分为两组,观察组术中麻醉维持持续静脉泵注右美托咪定1μg/kg(10min负荷量),维持0.8～1.0μg/(kg·h),瑞芬太尼0.2μg/(kg·min),间断静脉注入顺式阿曲库铵;对照组麻醉维持持续静脉泵入1%丙泊酚4～8mg/(kg·h)、瑞芬太尼0.2μg/(kg·min),间断静脉注入顺式阿曲库铵。使熵指数维持在40～60之间。监测并记录T0(基础值)、T1(喉罩置入)、T2(输尿管镜置入)、T3(碎石时)、T4(术毕清醒拔管)的MAP、HR、SpO2%、RE。结果 MAP、HR观察组与对照组相比,在麻醉期间差异有统计学意义(P<0.05);RE观察组与对照组相比,在麻醉期间差异无统计学意义(P>0.05);术后随访两组患者均无术中知晓。结论右美托咪定使血压,心率中度下降稳定围术期的血流动力学,有效地预防心肌缺血,降低全麻患者的心血管反应;右美托咪定的镇静作用可为输尿管镜气压弹道碎石手术提供有效的麻醉方法。
Objective To investigate the clinical effect of dexmedetomidine in ureteroscopic pneumatic lithotripsy. Methods Forty patients with ureteral calculi undergoing ureteroscopic pneumatic lithotripsy (ASA grading I ~ III) were divided into two groups. During the operation, the patients in the observation group received continuous intravenous infusion of dexmedetomidine 1 μg / kg (10 min load) , Maintained 0.8 ~ 1.0μg / (kg · h), remifentanil 0.2μg / (kg · min), intermittent intravenous cisatracurium; control anesthesia to maintain continuous intravenous infusion of 1% propofol 4 ~ 8mg / (kg · h), remifentanil 0.2μg / (kg · min), intermittent intravenous cisatracurium. Entropy index maintained at between 40 ~ 60. MAP, HR, SpO2% and RE of T0 (baseline), T1 (laryngeal mask placement), T2 (ureteroscopy), T3 (gravel) and T4 (extubated clear operation) were monitored and recorded. Results Compared with the control group, the MAP and HR observation groups had statistically significant differences (P <0.05) during anesthesia; there was no significant difference between the RE observation group and the control group during anesthesia (P> 0.05) Follow-up two groups of patients without intraoperative awareness. Conclusion Dexmedetomidine decreases blood pressure and heart rate moderately and stabilizes perioperative hemodynamics, effectively prevents myocardial ischemia and reduces cardiovascular reactions in general anesthesia patients. Dexmedetomidine can be used as ureteral Mirror pneumatic lithotripsy provides an effective method of anesthesia.