右美托咪定对亲属活体肾移植供体围术期肾功能的影响  

Effect of dexmedetomidine on donor's renal functions during living relative renal transplantation

作　　者：张雪兵 冯博 疏树华 Zhang Xuebin;Feng Bo;Shu Shuhua(Department of Anesthesiology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)麻醉科,合肥230001

出　　处：《中国临床保健杂志》2021年第3期353-357,共5页Chinese Journal of Clinical Healthcare

基　　金：安徽省学术和技术带头人科研活动经费资助项目(2017D147)。

摘　　要：目的探讨右美托咪定对亲属活体肾移植供体围手术期肾功能的影响。方法选择行亲属活体肾移植术供体60例,采用随机数字表法分成右美托咪定组(D组)和对照组(C组),每组30例。D组麻醉诱导前右美托咪定1μg/kg泵注10 min后以0.5μg·kg^(-1)·h^(-1)泵注至手术结束前30 min;C组以等容量0.9%氯化钠注射溶液以同等方式泵注至手术结束前30 min。分别在两组供体麻醉诱导前(T0)、供肾切除后1 h(T1)、供肾切除后24 h(T2)、供肾切除后48 h(T3)抽取静脉血检测血肌酐(Cr)、尿素氮(BUN)和胱抑素C(CysC)的浓度。记录各时间点的平均动脉压(MAP)、心率(HR)。记录两组患者液体输入量、尿量、丙泊酚使用量、瑞芬太尼使用量、多巴胺使用量。结果与C组对比,D组T1时BUN[(4.97±1.19)mmol/L]明显低于C组BUN的值[(6.49±1.52)mmol/L],P<0.05;D组CysC浓度T1时[(0.64±0.18)mg/L]明显低于C组[(0.99±0.21)mg/L],P<0.05;与C组对比,D组瑞芬太尼使用量[(1.6±0.2)mg]明显少于C组[(2.6±0.4)mg],P<0.05,尿量[(995±24.72)mL]明显多于C组[(750±19.86)mL],P<0.05。结论围手术期使用右美托咪定可以保护亲属活体肾移植供体肾功能。Objective To evaluate the effect of dexmedetomidine on donor's renal functions during the perioperative period of living relative renal transplantation.Methods Fourty patients(14 males,26 females,aged 41-69 years,ASA I-II),were randomly divided into two groups(n=20 each).Patients in dexmedetomindine group received a loading dose of dexmedetomindine 1μg/kg in 10 min and a continuous infusion of dexmedetomidine 0.5μg·kg^(-1)·h^(-1) until 30 min after donor nephrectomy,while patients in control group received equal capacity of saline until 30 min after donor nephrectomy.The veins were taken of the two groups of donor before anesthesia induction(T0),30 min after donor nephrectomy(T1),24 h after donor nephrectomy(T2),48 h after donor nephrectomy(T3),and 72 h after donor nephrectomy(T4).Blood was tested for the concentration of serum creatinine(Cr),urea nitrogen(BUN),and cysteine protease inhibitor C(CysC),fluid infusion and urine were recorded;warm ischemia time was recorded.Results Compared with T0,the concentration of urea nitrogen(BUN)in the dexmedetomidine group was significantly decreased at the T1(P<0.05);the concentration change of serum creatinine and cysteine protease inhibitor C(CysC)was not obvious(P>0.05);compared with the control group(group C),the concentrations of urea nitrogen(BUN)and cystatin C(CysC)in the dexmedetomidine group were significantly lower at the time of T1(P<0.05);there was no significant difference in serum creatinine(Cr),urea nitrogen(BUN)and cystatin C(CysC)between the two groups at T0,T2,T3 and T4(P>0.05).Compared with the control group(group C),the use dosage of remifentanil in the dexmedetomidine group(group D)was significantly reduced,the difference was statistically significant(P<0.05).Compared with the control group(group C),the dexmedetomidine group(group D)had significant increased urine volume.The difference was statistically significant(P<0.05);there was no significant difference in the amount of propofol used between the two groups;there was no significant difference in

关 键 词：肾移植 围手术期 活体供者 右美托咪啶 

分 类 号：R69[医药卫生—泌尿科学]