右美托咪定对体外循环冠状动脉旁路移植患者肾功能的影响
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摘要
目的探讨右美托咪定对体外循环冠状动脉旁路移植患者肾功能的影响。方法选取2014年6月至2016年6月于华北理工大学附属唐山市工人医院行体外循环冠状动脉旁路移植患者80例,完全随机分为观察组和对照组,各40例。观察组患者麻醉诱导前给予4 mg/L右美托咪定,以1μg/(kg·h)速率泵注至术毕;对照组患者予同等容量的0. 9%氯化钠注射液以1μg/(kg·h)速率泵注至术毕。分别于术前入室、术中关胸和术后24、48 h抽取患者静脉血测定血尿素氮、血肌酐、胱抑素C水平,同时记录术中及术后24 h患者尿量并进行组间比较。结果 2组患者术后24 h血肌酐、胱抑素C水平均明显高于术前,术后24、48 h血尿素氮水平均高于术前(均P <0. 05)。观察组术后24 h血肌酐、胱抑素C水平及术后24、48 h血尿素氮水平均低于对照组[(77±12)μmol/L比(91±21)μmol/L、(1. 10±0. 32) mg/L比(1. 29±0. 31) mg/L、(7. 8±2. 3) mmol/L比(9. 9±2. 0) mmol/L、(7. 5±2. 3) mmol/L比(9. 2±2. 1) mmol/L](均P <0. 05)。观察组和对照组术中及术后24 h尿量比较差异均无统计学意义(均P> 0. 05)。结论右美托咪定能有效减少体外循环冠状动脉旁路移植患者术后肾损伤,对肾脏具有一定的保护作用。
Objective To investigate the effect of dexmedetomidine on renal function in patients undergoing coronary artery bypass grafting with extracorporeal circulation. Methods Eighty patients undergoing coronary artery bypass grafting with extracorporeal circulation in Tangshan Gongren Hospital Affiliated to North China University of Science and Technology from June 2014 to June 2016 were randomly divided into observation group and control group,with 40 cases in each group. The observation group was administered dexmedetomidine4 mg/L,1 μg/( kg·h) and the control group was administered same volume of 0. 9% sodium chloride solution1 μg/( kg·h) from before anesthesia induction to the end of operation. Blood urea nitrogen( BUN),serum creatinine( Scr) and cystatin C( Cys C) were tested before operation,at the end of operation,24 h and 48 h after operation. Urine volume was recorded during operation and within 24 h after operation. Results Levels of Scr and Cys C at 24 h after operation and BUN at 24 h and 48 h after operation significantly increased than those before operation in both groups( all P < 0. 05). Levels of Scr and Cys C at 24 h after operation and BUN at 24 h and 48 h after operation in observation group were significantly lower than those in control group [( 77 ± 12) μmol/L vs( 91 ± 21) μmol/L,( 1. 10 ± 0. 32) mg/L vs( 1. 29 ± 0. 31) mg/L,( 7. 8 ± 2. 3) mmol/L vs( 9. 9 ± 2. 0) mmol/L,( 7. 5 ± 2. 3) mmol/L vs( 9. 2 ± 2. 1) mmol/L]( all P < 0. 05). There were no significant difference of urine volumes during operation and within 24 h after operation between observation group and control group( both P >0. 05). Conclusion Dexmedetomidine can reduce renal injury in patients undergoing coronary artery bypass grafting with extracorporeal circulation.
Objective To investigate the effect of dexmedetomidine on renal function in patients undergoing coronary artery bypass grafting with extracorporeal circulation. Methods Eighty patients undergoing coronary artery bypass grafting with extracorporeal circulation in Tangshan Gongren Hospital Affiliated to North China University of Science and Technology from June 2014 to June 2016 were randomly divided into observation group and control group,with 40 cases in each group. The observation group was administered dexmedetomidine4 mg/L,1 μg/( kg·h) and the control group was administered same volume of 0. 9% sodium chloride solution1 μg/( kg·h) from before anesthesia induction to the end of operation. Blood urea nitrogen( BUN),serum creatinine( Scr) and cystatin C( Cys C) were tested before operation,at the end of operation,24 h and 48 h after operation. Urine volume was recorded during operation and within 24 h after operation. Results Levels of Scr and Cys C at 24 h after operation and BUN at 24 h and 48 h after operation significantly increased than those before operation in both groups( all P < 0. 05). Levels of Scr and Cys C at 24 h after operation and BUN at 24 h and 48 h after operation in observation group were significantly lower than those in control group [( 77 ± 12) μmol/L vs( 91 ± 21) μmol/L,( 1. 10 ± 0. 32) mg/L vs( 1. 29 ± 0. 31) mg/L,( 7. 8 ± 2. 3) mmol/L vs( 9. 9 ± 2. 0) mmol/L,( 7. 5 ± 2. 3) mmol/L vs( 9. 2 ± 2. 1) mmol/L]( all P < 0. 05). There were no significant difference of urine volumes during operation and within 24 h after operation between observation group and control group( both P >0. 05). Conclusion Dexmedetomidine can reduce renal injury in patients undergoing coronary artery bypass grafting with extracorporeal circulation.
引文
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[7]杨国旺,李文志.右美托咪定肾脏保护作用研究进展[J].实用医学杂志,2016,32(8):1369-1371.DOI:10.3969/j.issn.1006-5725.2016.08.054.Yang GW,Li WZ.Research progress on renal protective effect of dexmedetomidine[J].The Journal of Practical Medicine,2016,32(8):1369-1371.DOI:10.3969/j.issn.1006-5725.2016.08.054.
[8]Cho JS,Shim JK,Soh S,et al.Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery[J].Kidney Int,2016,89(3):693-700.DOI:10.1038/ki.2015.306.
[9]Bulow NM,Colpo E,Pereira RP,et al.Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass[J].Braz J Med Biol Res,2016,49(4):e4646.DOI:10.1590/1414-431X20154646.
[10]Liu X,Xie G,Zhang K,et al.Dexmedetomidine vs propofol sedation reduces delirium in patients after cardiac surgery:a meta-analysis with trial sequential analysis of randomized controlled trials[J].J Crit Care,2017,38:190-196.DOI:10.1016/j.jcrc.2016.10.026.
[11]Chen Y,Zhang X,Zhang B,et al.Dexmedetomidine reduces the neuronal apoptosis related to cardiopulmonary bypass by inhibiting activation of the JAK2-STAT3 pathway[J].Drug Des Devel Ther,2017,11:2787-2799.DOI:10.2147/DDDT.S140644.
[2]石奎,柏雪燕,张艳玲,等.右美托咪定对老年骨折患者术后认知功能的影响及作用机制[J].解放军医药杂志,2018,30(1):98-101.DOI:10.3969/j.issn.2095-140X.2018.01.026.Shi K,Bai XY,Zhang YL,et al.Effect of dexmedetomidine on postoperative cognitive function in elderly patients with fracture and its mecha-nism[J].Medical&Pharmaceutical Journal of Chinese People's Liberation Army,2018,30(1):98-101.DOI:10.3969/j.issn.2095-140X.2018.01.026.
[3]赵丹洋,李文志.右美托咪定在心脏外科手术中的应用新进展[J].实用药物与临床,2016,19(9):1181-1184.DOI:10.14053/j.cnki.ppcr.201609032.Zhao DY,Li WZ.Recent progress of dexmedetomidine in cardiac surgery[J].Practical Pharmacy and Clinical Remedies,2016,19(9):1181-1184.DOI:10.14053/j.cnki.ppcr.201609032.
[4]Ammar AS,Mahmoud KM,Kasemy ZA,et al.Cardiac and renal protective effects of dexmedetomidine in cardiac surgeries:a randomized controlled trial[J].Saudi J Anaesth,2016,10(4):395-401.DOI:10.4103/1658-354X.177340.
[5]Djaiani G,Silverton N,Fedorko L,et al.Dexmedetomidine versus propofol sedation reduces delirium after cardiac surgery:a randomized controlled trial[J].Anesthesiology,2016,124(2):362-368.DOI:10.1097/ALN.0000000000000951.
[6]Bustamante-Munguira J,Jorge-Monjas P,Hernandez-Lorenzo A,et al.e Comment.Creatinine in the diagnosis of acute kidney injury following cardiac surgery with cardiopulmonary bypass[J].Interact Cardiovasc Thorac Surg,2015,21(4):470.DOI:10.1093/icvts/ivv252.
[7]杨国旺,李文志.右美托咪定肾脏保护作用研究进展[J].实用医学杂志,2016,32(8):1369-1371.DOI:10.3969/j.issn.1006-5725.2016.08.054.Yang GW,Li WZ.Research progress on renal protective effect of dexmedetomidine[J].The Journal of Practical Medicine,2016,32(8):1369-1371.DOI:10.3969/j.issn.1006-5725.2016.08.054.
[8]Cho JS,Shim JK,Soh S,et al.Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery[J].Kidney Int,2016,89(3):693-700.DOI:10.1038/ki.2015.306.
[9]Bulow NM,Colpo E,Pereira RP,et al.Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass[J].Braz J Med Biol Res,2016,49(4):e4646.DOI:10.1590/1414-431X20154646.
[10]Liu X,Xie G,Zhang K,et al.Dexmedetomidine vs propofol sedation reduces delirium in patients after cardiac surgery:a meta-analysis with trial sequential analysis of randomized controlled trials[J].J Crit Care,2017,38:190-196.DOI:10.1016/j.jcrc.2016.10.026.
[11]Chen Y,Zhang X,Zhang B,et al.Dexmedetomidine reduces the neuronal apoptosis related to cardiopulmonary bypass by inhibiting activation of the JAK2-STAT3 pathway[J].Drug Des Devel Ther,2017,11:2787-2799.DOI:10.2147/DDDT.S140644.