机构地区:[1]首都医科大学附属北京胸科医院麻醉科,北京101149 [2]解放军总医院第七医学中心麻醉科,北京100700 [3]解放军总医院第三医学中心麻醉科,北京100039
出 处:《临床误诊误治》2021年第8期59-64,共6页Clinical Misdiagnosis & Mistherapy
基 金:北京市科技委员会基金资助项目(Z1711000000417035)。
摘 要:目的探究不同剂量右美托咪定(Dex)对紫绀型先天性心脏病(CCHD)患儿术后肾功能的保护作用。方法选择2018年5月—2019年2月在体外循环(CPB)下心脏手术的CCHD 90例,根据随机数字表法分为对照组、低剂量组、高剂量组,每组30例,对照组静脉泵注0.9%氯化钠注射液,低剂量组和高剂量组于麻醉诱导前10 min均静脉泵注Dex 1μg/kg负荷剂量,随后分别以0.5和1μg/(kg·h)速度泵注至气管拔管。在气管插管后(T1)、超滤结束后(T2)、CPB结束后3 h(T3)、CPB结束后8 h(T4)、CPB结束后24 h(T5)收集各组血液和尿液标本检测并记录尿中性粒细胞明胶蛋白酶相关脂质运载蛋白(uNGAL)、血半胱氨酸蛋白酶抑制剂C(bCys-C)、尿肾损伤分子-1(uKIM-1)及患儿术后7 d的血肌酐值,比较3组术后急性肾损伤(AKI)发生率。结果T1和T2时,3组uNGAL、bCys-C、uKIM-1水平比较差异无统计学意义(P>0.05)。T3~T5时,低剂量组和高剂量组uNGAL、uKIM-1水平较对照组降低(P<0.05)。低剂量组bCys-C水平在T4和T5时较对照组降低,高剂量组在T5时较对照组显著降低(P<0.05)。低剂量组、高剂量组AKI发生率显著低于对照组(P<0.05)。结论CCHD患儿围术期推荐持续泵注Dex 0.5μg/(kg·h)可保护肾功能并降低AKI的发生率。Objective To investigate the protective effects of different doses of Dexmedetomidine on postoperative renal function in children with cyanotic congenital heart disease(CCHD).Methods A total of 90 infants with CCHD undergoing cardiac surgery under cardiopulmonary bypass(CPB)between May 2018 and February 2019 were divided into control group(group C,n=30),low-dose group(group L,n=30)and high-dose group(group H,n=30)according to random number table method.Group C was injected with 0.9%Sodium Chloride Injection by intravenous pump.Group L and H were given Dexmedetomidine 1μg/kg loading dose at the 10 th min before anesthesia induction,and then at the respective speed of 0.5μg/(kg·h)and 1μg/(kg·h)were pumped until the tracheal extubation after surgery.Blood and urine samples were collected immediately after tracheal intubation(T1),at the end of ultrafiltration(T2),at the 3 rd h after CPB(T3),at the 8 th h after CPB(T4)and the 24 th h after CPB(T5),and levels of urinary neutrophil gelatinase-associated lipocalin(uNGAL),blood cystatin C(bCys-C),urinary renal injury molecule 1(uKIM-1)and serum creatinine within 7 d after operation were detected and recorded.Incidence rates of acute kidney injury(AKI)after operation were compared among three groups.Results Levels of uNGAL,bCys-C and uKIM-1 at T1 and T2 were not statistically significant differences among three groups(P>0.05).Levels of uNGAL and uKIM-1 in group L and H were significantly lower than those in group C at T3-T5(P<0.05).Compared with those in group C,bCys-C levels at T4 and T5 were significantly lower in group L,while the level at T5 was significantly lower in group H(P<0.05).Incidence rates of AKI were significantly lower in group L and H than that in group C(P<0.05).Conclusion The 0.5μg/(kg·h)Dex continuous pump injection is recommended for cardiac surgery in infants with CCHD,which may protect renal function and reduce incidence rate of AKI after operation.
关 键 词:紫绀型先天性心脏病 右美托咪定 麻醉 急性肾功能损伤 中性粒细胞明胶蛋白酶相关脂质运载蛋白 半胱氨酸蛋白酶抑制剂C 尿肾损伤分子-1
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