右美托咪定对老年患者腹腔镜下根治性肾切除术围术期氧化应激、炎症及急性肾损伤的影响  

Effects of dexmedetomidine on oxidative stress,inflammation and acute kidney injury in elderly patients during laparoscopic radical nephrectomy

作　　者：苏雨薇 刘永哲 董钰妍 孙闻 邓浩伟 Su Yuwei;Liu Yongzhe;Dong Yuyan;Sun Wen;Deng Haowei(College of Anesthesia,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Third Medical Center,Chinese People′s Liberation Army General Hospital,Beijing 100059,China;Graduate School,Jinzhou Medical University,Jinzhou 121001,China;Institute of Military Cognition and Brain Science,Academy of Military Medical Sciences,Beijing 100850,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]中国人民解放军总医院第三医学中心麻醉科,北京100059 [3]锦州医科大学研究生学院,辽宁锦州121001 [4]军事科学院军事医学研究院军事认知与脑科学研究所,北京100850

出　　处：《实用药物与临床》2023年第7期614-619,共6页Practical Pharmacy and Clinical Remedies

摘　　要：目的研究右美托咪定(DEX)对老年患者腹腔镜下根治性肾切除术(LRN)围术期氧化应激、炎症及急性肾损伤(AKI)的影响。方法选择2022年1-8月解放军总医院第三医学中心接受LRN的肾细胞癌(RCC)患者90例为研究对象。根据随机数字表法将患者分为右美托咪定组和对照组,每组45例。右美托咪定组于麻醉诱导前15 min静脉泵注DEX 0.6μg/kg负荷剂量,随后持续泵注0.4μg/(kg·h)至术毕前半小时,对照组经静脉持续泵注相同剂量的0.9%氯化钠注射液。观察两组患者入室(T_(0))、气管插管即刻(T_(1))、开气腹时(T_(2))、拔管后即刻(T_(3))、出室前(T_(4))的平均动脉压(MAP)和心率(HR),术中拔管时间、尿量和血管活性药物使用情况,手术结束时间,住院天数及T_(0)和术后2 d(T_(6))血肌酐(SCr)、肾小球滤过率(eGFR)、尿素(Urea)、胱抑素C(Cys C)、β2微球蛋白(β2-MG)、C反应蛋白(CRP)。根据KDIGO指南诊断标准,诊断术后AKI及分期。检测T_(0)、T_(4)、术后1 d(T_(5))核因子E2相关因子2(Nrf2)、白细胞介素6(IL-6)、谷胱甘肽(GSH)、晚期氧化蛋白产物(AOPP)、超氧化物歧化酶(SOD)、丙二醛(MDA)、总抗氧化能力(T-AOC)。结果两组患者术后拔管时间、住院天数及AKI发生率和分级的差异均无统计学意义(P>0.05);右美托咪定组术中使用血管活性药物(麻黄碱)多于对照组,差异有统计学意义(P<0.05);T_(3)、T_(4)时右美托咪定组HR明显慢于对照组,差异有统计学意义(P<0.05);右美托咪定组T_(4)、T_(5)时的Nrf2、MDA、AOPP水平均低于对照组(P<0.05),GSH、SOD、T-AOC水平均高于对照组(P<0.05);右美托咪定组T_(4)、T_(5)各时间点IL-6水平均低于对照组,差异均有统计学意义(P<0.05);两组在T_(0)、T_(6)时的SCr、eGFR、Urea、Cys C、β2-MG、CRP水平比较差异均无统计学意义(P>0.05)。结论DEX能减轻老年患者LRN围术期氧化应激损伤及炎症反应,但不能降低LRN术后AKI发生率。Objective To investigate the effects of dexmedetomidine(DEX)on oxidative stress,inflammation and acute kidney injury(AKI)during laparoscopic radical nephrectomy(LRN)in elderly patients.Methods Ninety RCC patients who received LRN in the Third Medical Center of PLA General Hospital from January 2022 to August 2022 were selected as subjects.According to random number table method,patients were divided into dexmedetomidine group and control group,with 45 cases in each group.Dexmedetomidine group was given a load dose of DEX 0.6μg/kg by intravenous pump 15 min before anesthesia induction,and then continued to be pumped 0.4μg/(kg·h)until half an hour before surgery ended.Control group was continuously pumped the same dose of sodium chloride injection by intravenous pump.MAP and HR,intraoperative extubation time,urine volume and use of vasoactive drugs,duration of operation and length of hospital stay on entering operation room(T_(0)),immediately after endotracheal intubation(T_(1)),immediately after pneumoperitoneum opening(T_(2)),immediately after extubation(T_(3)),and before leaving the room(T_(4))were observed in two groups.T_(0)and postoperative 2d(T_(6))serum creatinine(SCr),glomerular filtration rate(eGFR),Urea(Urea),cystatin C(Cys C),β2 microglobulin(β2-MG)and C-reactive protein(CRP)were also observed.According to the diagnostic criteria of KDIGO guidelines,postoperative AKI and its staging were diagnosed.Nuclear factor E2-related factor 2(Nrf2),interleukin 6(IL-6),glutathione(GSH),advanced oxidized protein product(AOPP),superoxide dismutase(SOD),malondialdehyde(MDA),and total antioxidant capacity(T-AOC)were detected at T_(0),T_(4),1 day after surgery(T 5).Results There were no significant differences in postoperative extubation time,length of hospital stay incidence or grade of AKI between the two groups(P>0.05).The use of vasoactive drug(ephedrine)in dexmedetomidine group was higher than that in control group,and the difference was statistically significant(P<0.05).At T_(3)and T_(4),HR in dexmedetomidine

关 键 词：右美托咪定 根治性肾切除术 炎症 氧化应激 急性肾损伤 

分 类 号：R614[医药卫生—麻醉学] R737.11[医药卫生—外科学]