右美托咪定对心脏瓣膜置换患者术后急性肾损伤的影响  

The effect of dexmedetomidine on acute kidney injury after heart valve replacement:a propensity score-matched study

作　　者：孙斌 闫莉[1] 刘倩[1] 周美艳[1] 张妍 陈娇 吴从友[1] 王立伟[1] Sun Bin;Yan Li;Liu Qian;Zhou Meiyan;Zhang Yan;Chen Jiao;Wu Congyou;Wang Liwei(Department of Anesthesiology,Xuzhou Central Hospital,Jiangsu Xuzhou 221000,China)

机构地区：[1]徐州市中心医院麻醉科,徐州221000 [2]徐州市医学科学研究所,徐州221000

出　　处：《中国体外循环杂志》2023年第1期28-32,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(82071903);徐州市卫生健康委青年医学科技创新项目(XWKYHT20210591)。

摘　　要：目的评估右美托咪定预防心脏瓣膜置换患者术后急性肾损伤(AKI)的安全性与有效性。方法回顾性分析2016年1月至2021年12月在体外循环下行心脏瓣膜置换术的患者761例,根据围术期是否使用右美托咪定分为右美组和对照组,通过倾向性评分匹配法进行1∶1匹配,对比两组患者围术期的各项指标。结果匹配后每组103例配对成功,两组间基线特征无统计学差异。对比两组术后资料发现,右美组患者术后AKI发生率低于对照组(4.85%vs.12.62%,P=0.048),术后两组患者在肺部感染、凝血功能障碍、心律失常、再次开胸止血、切口不愈合、肝功能不全、脑血管意外、使用呼吸机>24 h、使用连续肾替代治疗、使用主动脉内球囊反搏以及30天生存率等方面无明显统计学差异(P>0.05)。结论右美托咪定可有效改善心脏瓣膜置换患者术后AKI的发生率,同时右美托咪定对该患者群体的长期益处值得进一步研究。Objective To evaluate the safety and efficacy of dexmedetomidine in the prevention of acute kidney injury(AKI)after heart valve replacement.Methods 761 patients who underwent heart valve replacement under cardiopulmonary bypass from January 2016 to December 2021 were retrospectively analysed and divided into dexmedetomidine group and control group according to whether dexmedetomidine was used during the operation or not.The propensity score matching(PSM)method was used for 1∶1 matching,and the perioperative indicators of the two groups were compared.Results After PSM,103 cases in each group were successfully matched,and there was no statistical difference in baseline characteristics between the two groups.Comparing the postoperative data of the two groups,it was found that the incidence of postoperative AKI in the dexamethasone group was lower than that in the control group(4.85%vs 12.62%,P=0.048).Postoperatively,there were no significant differences between the two groups in terms of pulmonary infection,coagulation dysfunction,arrhythmia,hemostasis,incision disunion,liver insufficiency,cerebrovascular accident,use of ventilator for>24 hours,use of CRRT,use of IABP,and the 30-day survival rate(P>0.05).Conclusion Dextrmetomidine can effectively decrease the incidence of AKI after cardiac valve replacement,and the long-term benefits of dextrmetomidine for these patients deserve further study.

关 键 词：心脏手术 瓣膜置换 体外循环 急性肾损伤 倾向性评分匹配 

分 类 号：R614[医药卫生—麻醉学]