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摘要：
目的 探究围术期应用右美托咪定对肾源性继发性甲状旁腺功能亢进（secondary hyperparathyroidism,SHPT）患者术后复发的影响。方法 回顾性分析2017年1月至2018年8月于安徽医科大学第二附属行甲状旁腺全切+自体移植术（total parathyroidectomy+ autologous transplantation，tPTX+AT）的354例终末期肾病SHPT患者的病历资料，随访患者术后一年内SHPT是否复发，分为复发组和未复发组，并对发生术后复发的可能相关因素进行单因素和多因素Logistic回归分析。根据术中是否输注右美托咪定将其分为右美托咪定组（DEX组）和对照组（CON组），比较两组围术期相关资料差异。结果 共36例SHPT患者术后出现复发，复发率为10.2%，即复发组36例，未复发组318例，133例患者术中使用了右美托咪定，即DEX组133例，CON组221例。①多因素Logistic回归分析发现，年龄（OR=1.081,95％CI 1.038 ~1.126,P0.001）、术后iPTH水平（OR=1.011,95％CI 1.000 ~1.021,P=0.041）与术中使用右美托咪定（OR=0.222,95％CI 0.083 ~0.594,P=0.003）是肾源性SHPT患者术后复发的影响因素；②与CON组相比，DEX组患者术中舒芬太尼使用量显著减少，PACU期间予以补救镇痛发生率显著降低，心动过缓发生率增高（P0.05），两组一般临床资料和其余围术期指标差异无统计学意义（P0.05）。 结论 术中使用右美托咪定是肾源性SHPT患者术后复发的保护性因素，并且能够减少术中阿片类药物用量，并提供更为良好的术后镇痛。
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Abstract: Objective To investigatethe effect of dexmedetomidine on postoperative recurrence in patients with renal secondaryhyperparathyroidism(SHPT). Methods Retrospective analysis the medical records of 354 patients with renal secondary parathyroid who underwent total parathyroidectomy + autologous transplantation (tPTX+AT) from January 2017 to August 2018 in the Second Affiliated of Anhui Medical University,all patients were followed up for recurrence of SHPT within one year after surgery, and they were divided into recurrence group and non-recurrence group. Univariate Logistic regression and multivariate Logistic regression were performed for the possible related factors of postoperative recurrenc. According to whether dexmedetomidine was infused during the operation, they were divided into dexmedetomidine group (DEX group) and control group (CON group), and the differences in perioperative data between the two groups were compared. Results A total of 36 patients with SHPT recurred after surgery, the recurrence rate was 10.2%, there were 36 cases in the recurrence group and 318 cases in the non-recurrence group,and 133 patients received dexmedetomidine during the operation, i.e., 133 cases in the DEX group and 221 cases in the CON group.①Multivariate logistic regression analysis suggests that age (OR=1.081, 95%CI 1.038 ~ 1.126, P0.001), postoperative iPTH level (OR=1.011, 95% CI 1.000 ~1.021, P=0.041) as well as intraoperative using dexmedetomidine (OR=0.222, 95%CI 0.083 ~0.594, P=0.003) are influencing factors for postoperative recurrence in patients with renal SHPT;②Compared with the CON group, the amount of sufentanil used in the DEX group was significantly reduced, and the incidence of salvage analgesia during PACU was significantly reduced, in addition,the incidence of bradycardia increased (P0.05). There was no significant difference between general clinical data and other perioperative indexes (P0.05). Conclusion Intraoperative using of dexmedetomidine is a protective factor for postoperative recurrence in patients with nephrogenic SHPT, and can reduce the amount of intraoperative opioids and provide better postoperative analgesia.
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