CAJ | 학술논문

目的：评价右美托咪定（Dex）应用于亲属活体肾移植终末期肾病（ESRD）受体手术麻醉的有效性与安全性。方法2013年10月至2014年12月在安徽医科大学附属省立医院行亲属活体肾移植的 ESRD 患者40例，随机分为 Dex 组及对照组各20例。Dex 组于麻醉诱导前给予 Dex 0.6μg／kg的负荷剂量，于20 min 内泵注完毕，继以0.2μg／（kg·h）泵注1 h 结束后随即行全身麻醉诱导；对照组泵注等量的生理盐水，两组的麻醉诱导及维持药物相同。观察并记录两组患者用药前（T0），用药后20 min （T1）以及置入喉罩前（T2）、置入喉罩后（T3）各时点的平均动脉压、心率及脑电双频指数（BIS）；观察有否苏醒延迟，苏醒期躁动情况。记录术中、术后（4、8、12、24 h）尿量以及术前、术后（12、24 h）内生肌酐清除率。结果与 T0比较，两组患者 T2的平均动脉压、心率及 BIS 值均明显下降（均为 P ＜0.05），两组间比较，Dex 组心率、BIS 下降更为明显（均为 P ＜0.05），但平均动脉压无明显下降（P ＞0.05）。Dex 组苏醒期躁动的发生率为15％（3／20），均为轻度躁动，与对照组（30％，6／20）比较明显下降（P ＜0.05）。Dex 组术中、术后4 h 及8 h 尿量均较相应时间的对照组明显增多（均为 P ＜0.05）。两组患者术后12 h 及24 h 内生肌酐清除率均较术前明显上升（均为 P ＜0.01）。结论右美托咪定可降低亲属活体肾移植受体苏醒期躁动发生率，增加术后尿量，无发生苏醒延迟，可安全用于 ESRD 患者。
목적：평개우미탁미정（Dex）응용우친속활체신이식종말기신병（ESRD）수체수술마취적유효성여안전성。방법2013년10월지2014년12월재안휘의과대학부속성립의원행친속활체신이식적 ESRD 환자40례，수궤분위 Dex 조급대조조각20례。Dex 조우마취유도전급여 Dex 0.6μg／kg적부하제량，우20 min 내빙주완필，계이0.2μg／（kg·h）빙주1 h 결속후수즉행전신마취유도；대조조빙주등량적생리염수，량조적마취유도급유지약물상동。관찰병기록량조환자용약전（T0），용약후20 min （T1）이급치입후조전（T2）、치입후조후（T3）각시점적평균동맥압、심솔급뇌전쌍빈지수（BIS）；관찰유부소성연지，소성기조동정황。기록술중、술후（4、8、12、24 h）뇨량이급술전、술후（12、24 h）내생기항청제솔。결과여 T0비교，량조환자 T2적평균동맥압、심솔급 BIS 치균명현하강（균위 P ＜0.05），량조간비교，Dex 조심솔、BIS 하강경위명현（균위 P ＜0.05），단평균동맥압무명현하강（P ＞0.05）。Dex 조소성기조동적발생솔위15％（3／20），균위경도조동，여대조조（30％，6／20）비교명현하강（P ＜0.05）。Dex 조술중、술후4 h 급8 h 뇨량균교상응시간적대조조명현증다（균위 P ＜0.05）。량조환자술후12 h 급24 h 내생기항청제솔균교술전명현상승（균위 P ＜0.01）。결론우미탁미정가강저친속활체신이식수체소성기조동발생솔，증가술후뇨량，무발생소성연지，가안전용우 ESRD 환자。
Objective To assess the effectiveness and safety of dexmedetomidine (Dex) in anesthesia for end-stage renal disease (ESRD)recipients in living related renal transplantation.Methods Forty ESRD patients undergoing living related renal transplantation in the Affiliated Provincial Hospital of Anhui Medical University from October 201 3 to December 201 4 were randomized into the Dex group and the control group,20 patients in each group.In the Dex group,the patients were pumped with the loading dose of Dex at 0.6 μg/kg before anesthesia induction and the procedure was completed within 20 min.Then,the patients were pumped at 0.2 μg/(kg·h)for 1 h and underwent general anesthesia induction.In the control group,the patients were pumped with equivalent normal saline.The anesthesia induction and the maintenance drug of the two groups were the same.The mean arterial pressure (MAP),heart rate (HR)and bispectral index (BIS) before administration (T0 ),20 min after administration (T1 ),before laryngeal mask placement (T2 )and after laryngeal mask placement (T3 )of the two groups were observed and recorded.Delayed recovery and emergence delirium were also observed.Urine output during transplantation,4,8,1 2,24 h after transplantation,as well as endogenous creatinine clearance rate (Ccr)before transplantation and 1 2,24 h after transplantation were recorded.Results Compared with T0 ,the MAP,HR and BIS of the two groups at T2 decreased significantly (all in P <0.05).As for the comparison between two groups,the HR and BIS of the Dex group decreased significantly (both in P <0.05 ),but the MAP didn't decrease significantly (P >0.05 ).The emergence delirium in the Dex group was all mild with the incidence of 1 5% (3 /20),which significantly deceased in comparison with that in the control group (30%,6 /20)(P <0.05).The urine outputs of Dex group during transplantation,and 4 h and 8 h after transplantation were significantly higher than those of the control group (all in P <0.05).The Ccr of the two groups at 1 2 h and 24 h after transplantation significantly increased, compared with that before transplantation (all in P <0.01 ).Conclusions Dex may reduce the incidence of emergence delirium of recipient in living related renal transplantation,increase urine output after transplantation and cause no delayed recovery,which may be used in ESRD patients safely.