目的: 研究右美托咪定及咪达唑仑腰硬联合麻醉在双侧肾结石患者中的应用价值。方法: 选取本院双侧肾结石患者100例,按照随机抽签法分为观察组和对照组,各50例。均采取经皮肾镜碎石术(PCNL)治疗。观察组采取右美托咪定+咪达唑仑腰硬联合麻醉,对照组给予静脉咪达唑仑腰硬联合麻醉,比较两组给药前(T0)、给药后10 min(T1)、俯卧位后(T2)、俯卧位1 h(T3)、术毕(T4)警觉/镇静(OAA/S)评分、血流动力学指标[血氧饱和度(SpO2)、平均动脉压(MAP)、心率(HR)]、手术前后肾功能[血清胱抑素C(Cys-C)、视黄醇结合蛋白(RBP)、尿素氮(BUN)]水平、肾脏损伤指标[尿α1-微球蛋白(α1-MG)、微量白蛋白(umAlb)]水平及不良反应发生情况。结果: (1)镇静效果:观察组T1、T2、T3、T4时间点OAA/S评分低于对照组(P＜0.05);(2)血流动力学:两组SpO2 T0～T4无明显波动(P＞0.05);两组MAP T0～T4波动幅度无明显差异(P＞0.05);观察组HR T3～T4波动幅度低于对照组(P＜0.05);(3)肾功能:观察组术毕即刻、术后3 d血清Cys-C、RBP水平较对照组低(P＜0.05);(4)肾脏损伤指标:观察组术毕即刻、术后3 d尿umAlb、α1-MG水平较对照组低(P＜0.05);(5)不良反应发生情况:与对照组比较,观察组不良反应总发生率、低血压、谵妄发生率低(P＜0.05);心动过缓发生率较对照组高,但差异无统计学意义(P＞0.05)。结论: 右美托咪定及咪达唑仑腰硬联合麻醉应用于双侧肾结石患者,可取得显著镇静效果,维持血流动力学稳定,降低肾脏损伤程度,保护肾功能,还可降低谵妄、低血压等不良反应发生率,但需注意心动过缓现象。
Objective: To study the application value of dexmedetomidine and midazolam combined spinal-epidural anesthesia in patients with bilateral renal calculi. Methods: A total of 100 patients with bilateral renal calculi in our hospital were selected and randomly divided into observation group and control group, with 50 cases in each group. All patients were treated with percutaneous nephrolithotomy (PCNL). The observation group was given dexmedetomidine + midazolam combined spinal-epidural anesthesia, and the control group was given intravenous midazolam combined spinal-epidural anesthesia. The scores of alertness/sedation (OAA/S) before administration (T0), 10 min after administration (T1), after prone position (T2), 1 h after prone position (T3), after operation (T4), hemodynamic indexes [blood oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR)], renal function before and after operation [serum cystatin C (Cys-C), retinol binding protein (RBP), urea nitrogen (BUN)], renal injury indexes [urinary α1-microglobulin (α1-MG), microalbumin (umAlb)] and adverse reactions were compared between the two group. Results: (1)Sedative effect: the OAA / S scores at T1, T2, T3 and T4 time points in the observation group were lower than those in the control group (P＜0.05). (2)Hemodynamics: there was no significant fluctuation in the SpO2 at T0~T4 time points between the two groups (P＞0.05); there was no significant difference in the amplitude of MAP at T0~T4 time points between the two groups (P＞0.05); the fluctuation range of HR at T3~T4 time points in the observation group was lower than that in the control group (P＜0.05); (3)Renal function: the levels of serum Cys-C and RBP in the observation group were lower than those in the control group immediately after operation and 3 days after operation (P＜0.05). (4)Renal injury index: the levels of urinary umAlb and α1-MG in the observation group were lower than those in the control group immediately after operation and 3 days after operation (P＜0.05); (5)Adverse reactions: Incidence of adverse reactions : total incidence of adverse reactions, hypotension and delirium in the observation group were lower than those in the control group (P＜0.05); the incidence of bradycardia was higher than that in the control group, but there was no significant difference (P＞0.05). Conclusion: Dexmedetomidine of dexmedetomidine and midazolam combined spinal-epidural anesthesia in patients with bilateral renal calculi can achieve significant sedative effect, maintain hemodynamic stability, reduce renal damage, protect renal function, and reduce the incidence of adverse reactions such as delirium and hypotension, but attention should be paid to bradycardia.
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