右美托咪定对体外循环下瓣膜置换术后患者急性肾损伤的影响  

Effect of dexmedetomidine on acute kidney injury after cardiac valve replacement with cardiopulmonary bypass

作　　者：薛峰[1] 张伟[2] 张晓[1] 江岩[1] 褚海辰[1] 

机构地区：[1]青岛大学附属医院麻醉科,266003 [2]青岛大学附属医院肾内科,266003

出　　处：《中华麻醉学杂志》2016年第10期1171-1174,共4页Chinese Journal of Anesthesiology

基　　金：青岛大学附属医院青年基金（2406）;山东省医药卫生科技发展计划（2015WS0346）

摘　　要：目的评价右美托咪定对体外循环下瓣膜置换术后患者急性肾损伤的影响。方法择期拟行心脏瓣膜置换术的风湿性心脏病患者100例，性别不限，年龄32～64岁，体重46—75kg，ASA分级Ⅱ或Ⅲ级，NYHA分级Ⅱ或Ⅲ级，采用随机数字表法分为2组（n=50）：对照组（C组）和右美托咪定组（D组）。D组于常规麻醉诱导前经10min静脉输注右美托咪定1μg／kg负荷量，随后以0．4μg·kg-1·h-1的速率输注至术后24h，C组静脉输注等容量生理盐水。记录患者术后48h内每小时尿量，于术后6、12、24、36和48h时取肘正中静脉血样，测定血清肌酐水平。根据尿量及血清肌酐水平判断急性肾损伤的发生情况及严重程度。结果与c组比较，D组术后48h内急性肾损伤的发生率及严重程度明显降低（P〈0．05）。结论诱导前经10min静脉输注右美托咪定1μg／kg负荷量，随后以0．4μg·kg-1·h-1的速率输注至术后24h可降低体外循环下心脏瓣膜置换术后患者急性肾损伤的发生，且减轻其严重程度。Objective To evaluate the effect of dexmedetomidine on acute kidney injury after car- diac valve replacement with cardiopulmonary bypass （CPB）. Methods One hundred patients of both se- xes with rheumatic heart disease, aged 32-64 yr, weighing 46-75 kg, of American Society of Anesthesiol- ogists physical statusⅡ or Ⅲ（New York Heart Association class Ⅱ or Ⅲ） , scheduled for elective cardiac valve replacement with CPB, were divided into 2 groups （n = 50 each） using a random number table： con- trol group （group C） and dexmedetomidine group （group D）. Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg over 10 rain before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation in group D, while the equal volume of normal saline was given in group C. The urine output per hour during the postoperative 48 h period was recorded. At 6, 12, 24, 36 and 48 h after operation, blood samples were collected from the median cubital vein for determination of ser- um creatinine levels. The development and severity of acute kidney injury were determined according to the urine output and serum creatinine level. Results Compared with group C, the incidence and severity of acute kidney injury were significantly decreased in the postoperative 48 h period in group D （P〈0. 05）. Conclusion Dexmedetomidine infused in a loading dose of 1 μg/kg over 10 min before induction of anes- thesia followed by an infusion of 0. 4 μg · kg-1 · h-1 until 24 h after operation can reduce the development and severity of acute kidney injury after cardiac valve replacement with CPB in patients.

关 键 词：右美托咪啶 体外循环 心脏瓣膜假体植入 肾功能不全 急性 

分 类 号：R614[医药卫生—麻醉学]