右美托咪啶对糖尿病创伤患者围术期肾功能的影响  

Effects of intraoperative application of dexmedetomidine on perioperative renal function of patients with diabetes mellitus complicated by acute trauma

作　　者：刘朋[1] 赵爽[1] 刘飞飞[1] 吴川[1] 王秀丽[1] 

机构地区：[1]河北医科大学第三医院麻醉科,石家庄市050051

出　　处：《河北医药》2018年第2期175-177,182,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:1120140248)

摘　　要：目的评价右美托咪啶对合并糖尿病的创伤患者围术期肾功能的影响。方法选择急症创伤手术患者60例,临床确诊糖尿病病史3年以上,性别不限,年龄35~75岁,体重50~80 kg,ASA分级Ⅱ级或Ⅲ级,随机分为2组:对照组(C组)和右美托咪啶组(D组)。术前禁食水6~8 h,麻醉选择均为全身麻醉,右美托咪啶组(D组)在术前10 min内静脉泵注右美托咪啶1μg/kg,术中持续泵注右美托咪啶0.5μg·kg^(-1)·h^(-1),对照组(C组)给予等量0.9%氯化钠溶液。于麻醉前(T0)、手术开始后30 min(T1)、手术结束前10 min(T2)、术后1 d(T3),3 d(T4),7 d(T5)空腹抽取肘静脉血,采用放射性免疫法测定血浆肌酐(Scr)、血尿素氮(BUN)和半胱氨酸蛋白酶抑制剂C(Cys C)浓度,酶学法测定血糖(GLU)水平。结果与麻醉前(T0)比较,C组T1、T2、T3时间点血浆胱抑素浓度升高(P<0.05),T2、T3、T4时间点血浆Scr和BUN浓度升高,T3时间点GLU浓度升高(P<0.05);D组T1、T2时间点Cys C浓度升高,其余时间点血浆Scr、BUN、Cys C和GLU浓度的差异无统计学意义(P>0.05)。与C组比较,D组T1、T2、T3时间时间点血浆Cys C浓度降低(P<0.05),T2、T3、T4时间点血BUN浓度降低,T2、T3时间点GLU浓度降低(P<0.05)。结论术中应用右美托咪啶对合并糖尿病的创伤患者肾功能具有保护作用。Objective To investigate the effects of intraoperative application of dexmedetomidine on perioperative renal function of patients with diabetes mellitus complicated by acute trauma. Methods Sixty patients with diabetes mellitus（ more than 3 years） complicated by acute trauma whose age range was 35 ~ 75 years,body weight 50 ~ 80 kg,ASA grade Ⅱ or grade Ⅲ,were randomly divided into dexmedetomidine group（ group D） and control group（ group C）. All the patients were treated by 6-8 hour fasting before operation and were given general anaesthesia,in addition,the patients in group D were given dexmedetomidine 1μg/kg by intravenous pump infusion on 10 min before operation,with intravenous pump infusion of dexmedetomidine 0. 5μg·kg^-1·h^-1 during operation,however,the patients in group C were given same volume physiological saline. The serum levels of creatinine（ Scr）,blood urea nitrogen（ Cys C） and cysteine protease inhibitor C（ BUN） before anesthesia（ T0）,30 min after operation（ T1）,10 min before the end of operation（ T2）,on 1 d（ T3）,3 d（ T4）,7 d（ T5） after operation were detected by radioimmunoassay,in addition the levels of blood glucose（ GLU） were detected（ enzymology method） and compared between two groups. Results As compared with those in T0,the plasma levels of Cys C in group C were significantly increased in T1,T2,T3（ P〈0. 05）,and the levels of BUN and Scr were increased in T2,T3,T4,moreover,the levels of GLU were increased in T3 in group C（ P〈0. 05）. However the plasma levels of Cys C were significantly increased in group D in T1,T2（ P〈0. 05）,but there were no significant differences in the levels of Cys C,BUN,Scr and GLU among the other time points（ P〉0. 05）. As compared with those in group C,the plasma levels of Cys C in group D were significantly decreased in T1,T2,T3,and the levels of BUN were significantly decreased in T2,T3,T4,moreover the levels of GLU were significantly decreased in T2,T3（ P〈0. 05）. Conclusion T

关 键 词：右美托咪啶 糖尿病 创伤 肾功能 

分 类 号：R971.2[医药卫生—药品]