右美托咪定与曲马多用于预防经皮肾镜取石术全麻恢复期寒战的比较

目的 观察右美托咪定和曲马多预防经皮肾镜取石术（PCNL）全麻恢复期寒战的效果.方法 在全麻下行PCNL患者90例,ASA Ⅰ-Ⅱ级,随机分为右美托咪定组（D组）、曲马多组（T组）、对照组（C组）,每组30例,手术结束前30 min,D组给予0.5μg/kg右美托咪定,T组给予1 mg/kg曲马多,均稀释至10 mL,C组给予10 mL生理盐水,使用静脉微量注射泵10 mL/min恒速输注,观察记录患者拔出导管后10、30、60 min的平均动脉压（MAP）、RR、SpO2、Ramsay镇静分级和VAS疼痛评分,记录寒战分级、寒战发生率.结果 D组和T组VAS评分明显低于C组,但D组和T组间差异无统计学意义;D组在观察各时点Ramsay评分明显高于T组和C组,T组和C组间差异无统计学意义;D组（3.3％）和T组（6.6％）寒战发生率及发生程度明显低于C组（30％）,两组比较差异有统计学意义.结论 右美托咪定和曲马多都可有效预防经皮肾镜取石手术患者全麻后寒战的发生,减少术后疼痛.

Comparison between dexmedetomidine and tramadol in preventing shivering under percutaneous nephrolithotomy during the anesthesia recovery period

Objective To observe the effects of preventing shivering of dexmedetomidine and tramadol in percutaneous nephrolithotomy （PCNL）during the anesthesia recovery period. Methods 90 patients ASA I - II undergo ing PCNL were randomly divided into dexmedetomidine group（ group D） , tramadol group （group T）and control group （group T）,30 cases in each group. All patients received general anesthesia. Dexmdetomidine 0. 5 μg/kg, tramadol 1 mg/kg, or saline was administered in via intravenous pump infusion within 30 rain before the end of surgery. MAP, RR, SpO2 were recorded at the following time points： 10 rain, 30 min, 60 rain after tracheal extubation, Ramsay sedation scale,VAS, the rate and grade of shivering were recorded too. Results VAS in group D and group T were significantly lower than that in control group （ P 〈 0. 05 ）, but the difference was not significant between group D and group T （P 〉 0. 05 ）. Ramsay sedation scale in group D were signicantly higher than that in group T and group C. The rate and grade of shivering were significantly lower in group D（3.3% ） and group T（6.6% ） compared with the control group （ 30% ）. Conclusion Dexmedetomidine and tramadol are suitable for the reduction of postoperative shivering and pain in PCNL.