硫氮卓酮对体外循环心脏手术后肾功能的影响

A Clinical Investigation of Diltiazem's Effects on Renal Function in Undergoing Cardiopulmonary Bypass

目的探讨硫氮卓酮对体外循环心脏手术后肾功能的影响。方法将40例择期心脏瓣膜置换术患者随机分成两组,每组20例。实验组(硫氮卓酮组)从体外循环(cardiopulmonary bypass,CPB)开始后用硫氮卓酮2μg/(kg.min)经静脉途径给药,持续1.5 h。对照组(只给等量的5%葡萄糖溶液)。分别于麻醉前、CPB期间、CPB终止后4 h、CPB终止后12 h分别测血清肌酐清除率、尿α1微球蛋白(α1-microglobulin,α1-MG),尿β2微球蛋白(β2-microglobulin,β2-MG)。结果①麻醉前两组患者血清肌酐清除率、尿α1-MG,尿β2-MG均无显著性差异(P>0.05)。②CPB后与麻醉前相比,两组患者血肌酐清除率在CPB期间、CPB终止后4 h均较麻醉前低,但对照组低于实验组(P<0.05),两组到CPB终止后12 h均基本恢复到麻醉前水平(P>0.05)。③CPB期间、CPB终止后4h、CPB终止后12 h两组患者尿α1-MG、β2-MG均较麻醉前高(P<0.05),但对照组高于实验组(P<0.05)。结论CPB对肾功能有损害作用;硫氮卓酮对CPB后的肾功能有保护作用。

Objective Objective To investigate the effects of diltiazem on renal function in patients who underwent cardiopulmonary bypass. Methods Forty cases of ASA grade Ⅱ-Ⅲ undergoing replacement of valve under cardiopulmonary bypass were divided into two groups：Treated group（n= 20）receiving a continuous intravenous infusion of diltiazem at 2 μg/（kg · min） from the beginning of CPB and continue for 1.5 hours. Control group（n= 20）received no diltiazem. Cr clear ratio （CCR）, urine-α1-microglobulin, urine-β1-microglobulin were measured before anesthesia,the duration of CPB,4 hours after CPB and 12 hours after CPB. Results ①Before anesthesia there is no remarkable difference between two groups in CCR,u-α1-MG and u-β1-MG（P〉0.05）. ②In the end of CPB,4 hours after CPB,the level of CCR obviously decreased in the two groups respectively（P〈0.05）, and it was obviously lower in Control group than Treatment group（P〈 0.05） ,but it came back to the base line until 12 hours after CPB in two groups（P〉0.05）. ③In the duration of CPB,4 hours after CPB, 12 hours after CPB,the levels of u-α1-MG and u-β1-MG obviously increased in the two groups respectively （P 〈0.05）, and it was obviously lower in Treatment group than Control group （P 〈 0.05）. Conclusion Cardiopulmonary bypass have a negative effect on renal function. Diltiazem has protection on renal function in patients who undergoing cardiopulmonary bypass.