标题：右美托咪定对全麻下经尿道输尿管镜钬激光碎石术患者应激反应和肾功能的影响

      作者：李婷，杨春艳，丘妙玲    (梅州市人民医院麻醉二科，广东 梅州 514000)

      卷次： 2017年28卷18期

      【摘要】 目的 评估右美托咪定对全麻下经尿道输尿管镜钬激光碎石术患者应激反应及肾功能的影响。方法 采用入院单双号法随机将梅州市人民医院 2016年 1月至 2017年 1月择期行全麻下经尿道输尿管钬激光碎石术的 57例患者分为观察组(右美托咪定，29例)与对照组(等容积生理盐水，28例)，比较两组患者右美托咪定输注前(T0)、气管插管即刻(T1)、气管拔管时(T2)、拔管后 10 min (T3)的心率(HR)、平均动脉压(MAP)、Ramsay镇静评分及血浆肾上腺素、皮质醇水平，及手术开始前即刻(T4)、手术结束即刻(T5)、术后第1天(T6)血肌酐(Scr)、尿素氮(BUN)、胱抑素C(Cys-C)水平，并记录两组不良反应。结果 观察组患者T2时HR，T1、T2、T3时MAP、血浆皮质醇、肾上腺素均明显低于对照组，差异均有统计学意义(P<0.05)；观察组患者T1、T2时的Ramsay评分分别为(4.41±0.68)分、(4.25±0.34)分，均明显高于对照组的(3.72±0.56)分、(2.67±0.52)分，差异均有统计学意义(P<0.05)；观察组患者T5、T6时Cys-C水平[(1.24±0.33) mg/L、(1.44±0.35) mg/L]均显著低于对照组[(2.90±0.35) mg/L、(2.55±0.27) mg/L]，差异均有统计学意义(P<0.05)；观察组患者的不良反应发生率10.34%，明显低于对照组的35.71%，差异有统计学意义(P<0.05)。结论 右美托咪定能有效稳定患者血流动力学指标，抑制应激反应，镇静效果良好，不良反应少，同时对肾功能有一定的保护作用。
      【关键词】 经尿道输尿管镜钬激光碎石；右美托咪定；应激反应；肾功能
      【中图分类号】 R699 【文献标识码】 A 【文章编号】 1003—6350(2017)18—2985—04

Effect of dexmedetomidine on stress response and renal function in patients undergoing transurethralureteroscopic holmium laser lithotripsy under general anesthesia.
LI Ting, YANG Chun-yan, QIU Miao-ling. theSecond Department of Anesthesia, the People's Hospital of Meizhou City, Meizhou 514000, Guangdong, CHINA
【Abstract】 Objective To evaluate the effect of dexmedetomidine on stress response and renal function in pa-tients undergoing transurethral ureteroscopic holmium laser lithotripsy under general anesthesia. Methods A total of 57patients undergoing elective transurethral ureteroscopic holmium laser lithotripsy under general anesthesia in the People'sHospital of Meizhou City from January 2016 to January 2017 were divided into the observation group (dexmedetomidine,n=29) and the control group (the same volume of normal saline, n=28). The heart rate (HR), mean arterial pressure(MAP), Ramsay score, levels of of plasma adrenaline and cortisol before the infusion of dexmedetomidine (T0), at trache-al intubation (T1), at tracheal extubation (T2) and 10 min after extubation (T3), levels of serum creatinine (Scr), bloodurea nitrogen (BUN) and cystatin C (Cys-C) immediately before operation (T4), at the end of operation (T5) and on the 1stday after operation (T6) were compared between the two groups, and the adverse reactions in the two groups were record-ed. Results HR at T2, MAP, plasma cortisol and adrenaline at T1, T2 and T3, in the observation group were significant-ly lower than those in the control group (P<0.05). At T1 and T2, Ramsay scores of the observation group were (4.41±0.68) and (4.25±0.34), which were significantly higher than (3.72±0.56) and (2.67±0.52) of the control group (P<0.05).At T5 and T6, Cys-C levels in the observation group were (1.24±0.33) mg/L and (1.44±0.35) mg/L, which were signifi-cantly lower than (2.90±0.35) mg/L and (2.55±0.27) mg/L in the control group (P<0.05). The incidence of adverse reac-tions in the observation group was significantly lower than those in the control group (10.34% vs 35.71% ) (P<0.05).Conclusion Dexmedetomidine can effectively stabilize the hemodynamic indexes and inhibit the stress response in pa-tients. Its sedative effect is good and adverse reactions are few, which also can protect the renal function.
      【Key words】 Transurethral ureteroscopic holmium laser lithotripsy; Dexmedetomidine; Stress response; Renalfunction·论 著·doi:10.3969/j.issn.1003-6350.2017.18.017