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.
MU Chao
,
YANG Rui
,
YANG Jiazhou
. Effects of dexmedetomidine and midazolam combined spinal-epidural anesthesia on renal function, urinary α1-microglobulin and microalbumin in patients with bilateral renal calculi[J]. Journal of Baotou Medical College, 2022
, 38(10)
: 39
-44
.
DOI: 10.16833/j.cnki.jbmc.2022.10.008
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