右美托咪定对异体肾移植患者围术期肾功能的影响

Effect of dexmedetomidine on renal functions during renal transplantation patients

中文关键词: 右美托咪定  肾移植  肾功能

英文关键词: Dexmedetomidine  Renal transplantation  Renal function

中文摘要:

      
目的 研究右美托咪定对同种异体肾移植患者围术期肾功能的影响。
方法 选择行同种异体肾移植患者60例,男36例,女24例,年龄25～45岁,ASA Ⅱ 或 Ⅲ 级,随机分为两组:右美托咪定组和对照组,每组30例。右美托咪定组麻醉诱导前给予右美托咪定1 μg/kg泵注10 min,随后以0.6 μg·kg^-1·h^-1维持泵注至手术结束前30 min;对照组以等容量生理盐水维持至手术结束前30 min。记录两组患者在麻醉诱导前(T1)、吻合血管开放前(T2)、吻合血管开放后即刻(T3)、吻合血管开放后30 min(T4)和手术结束后(T5)的HR和SBP,于T2、T4、术后24 h(T6)及术后48 h(T7)采取静脉血检测血尿素氮(BUN)、血肌酐(Cr)、IL-18和半胱氨酸蛋白酶抑制剂C(Cys C)的浓度;记录术中液体输注量和尿量。
结果 T3时右美托咪定组HR明显慢于对照组;T2、T3时右美托咪定组SBP明显高于对照组(P<0.05)。与T2时比较,T6、T7时两组Cys C、BUN、Cr浓度明显降低,且T7时右美托咪定组Cys C浓度明显低于对照组(P<0.05)。与T2时比较,T6、T7时两组IL-18浓度明显降低,且右美托咪定组降低幅度明显大于对照组(P<0.05)。右美托咪定组围术期尿量明显多于对照组(P<0.05)。两组术中液体输注量差异无统计学意义。
结论 围术期应用右美托咪定可有效保护肾移植患者的肾功能。

英文摘要:

      
Objective To evaluate the effect of dexmedetomidine on renal functions during the anesthesia of renal transplantation.
Methods Sixty patients (36 males, 24 females, aged 25-45 years, ASA physical status Ⅱ or Ⅲ), were randomly divided into two groups (n=30 each). Patients in dexmedetomidine group received a loading dose of dexmedetomidine 1 μg/kg within 10 min)and a continuous infusion of dexmedetomidine 0.6 μg·kg^-1·h^-1 until 30 min toward the end of surgery, while patients in control group received 0.9% sodium chloride injection to maintain equal capacity until 30 min before the end of surgery. Artery systolic blood pressure and heart rate were recorded before anesthesia induction (T1), before vascular anastomosis opening (T2), immediately after vascular anastomosis opening (T3), 30 min after vascular anastomosis opening (T4), after the surgery (T5), venous blood was collected in T2, T4, 24 h after surgery (T6) and 48 h after surgery (T7) to detect the blood urea nitrogen (BUN), serum creatinine (Cr), IL-18 and Cystatin C (Cys C); fluid infusion and urine were recorded.
Results Compared with control group, HR of dexmedetomidine group was reduced at T3, SBP of dexmedetomidine group was elevated at T2, T3(P<0.05). Compared with T2, Cys C, BUN, Cr of two groups decreased significantly at T6, T7, and Cys C of dexmedetomidine group was lower than that of control group (P<0.05). Compared with T2, IL-18 of the two groups reduced significantly at T6 and T7, and lowered amplitude in the dexmedetomidine group was greater than that in the control group (P<0.05). Perioperative urine volume in the dexmedetomidine group was more than that in the control group (P<0.05). There was no difference in perioperative fluid infusion between the two groups.
Conclusion Perioperative continuous infusion of dexmedetomidine might effectively improve the renal function of renal transplantation patients.