盐酸右美托咪定对急性脑外伤患者围术期氧化应激反应及肾功能的影响

Effects of dexmedetomidine on perioperative oxidative stress reaction and renal function in patients with acute brain injury

目的探讨盐酸右美托咪定对急性脑外伤患者围术期氧化应激反应及肾功能的影响。方法 2012年3月至2014年7月将收治的82例拟行急诊手术的脑外伤患者随机分为观察组和对照组,各组均为41例。观察组患者于麻醉诱导前至术后3天给予静脉输注盐酸右美托咪啶治疗(0.5μg·kg-1·h-1),对照组给予等剂量生理盐水处理;分别在麻醉诱导前、术毕、术后第1天、术后第3天及术后第5天抽取静脉血测定血肌酐(Cr)及血尿素氮(BUN)、血浆丙二醛含量(MDA)、超氧化物歧化酶活性水平(SOD),同时在相同时间点留取尿标本测定微量白蛋白(Alb)及N-乙酰-β-D-氨基葡萄糖苷酶(NAG)含量。结果两组患者MDA在术毕至术后3 d明显高于麻醉诱导前(P<0.05),观察组MDA在术毕至术后5 d低于对照组(P<0.05)。两组患者SOD水平在术毕至术后3 d明显低于麻醉诱导前(P<0.05),观察组SOD在对应时刻高于高于对照组(P<0.05)。两组围术期血Cr及BUN并未出现明显的统计学变化(P>0.05)。两组尿Alb/Cr和NAG/Cr在术毕至术后3 d明显增高(P<0.05),均在术后1 d达到高峰后逐渐回落,观察组尿Alb/Cr和NAG/Cr在术毕至术后5 d低于对照组(P<0.05)。经Pearson相关分析显示:血浆MDA在麻醉诱导前及术后各检测时间点分别与Alb/Cr和NAG/Cr呈正相关(P<0.05),而SOD分别与Alb/Cr和NAG/Cr呈负相关(P<0.05)。结论盐酸右美托咪啶可明显抑制急性脑外伤患者的氧化应激反应,减轻早期肾脏损害,在保护围术期肾功能方面具有一定的临床意义。

Objective To explore the effects of dexmedetomidine on perioperative oxidative stress reaction and renal function in patients with acute brain injury. Methods In March 2012 to July 2014,82 cases with brain injury of emergency operation in our hospital were included into this study. All patients were randomly divided into observation group and control group,each group of 41 cases. Patients in the observation group postoperative 3 days prior to the anesthesia induction were given intravenous hydrochloric acid right beauty holds the mi treatment（ 0. 5 mu h g,kg（ 1,1）. The patients of control group were given isodose physiological saline treatment. Before anesthesia induction,finish operation,postoperative day 1,3 days and 5 days after extraction of venous blood serum creatinine（ Cr） and blood urea nitrogen（ BUN）,plasma malondialdehyde（ MDA） content,superoxide dismutase（ SOD） activity level were detected. And the same time points to return for the determination of trace albumin in the urine specimen（ propagated） and n- acetyl- beta- D- amino glycosidase enzymes（ NAG） content were calculated. Results Two groups of patients with MDA in bi ~ were significantly better than the 3 d before anesthesia induction（ P〈0. 05）. The observation group of MDA in bi ~ 5 d after operation is lower than the control group（ P〈0. 05）. Two groups of SOD in bi ~ 3 d after operation in patients with significantly lower before anesthesia induction（ P〈0. 05）. The observation group of SOD in the corresponding moment is higher than higher than the control group（ P〈0. 05）. Two groups of perioperative blood Cr and BUN were not obvious statistical change（ P〉0. 05）. Two groups of urine propagated / Cr and NAG / Cr in bi ~ 3 d post- operational significantly higher（ P〈0. 05）,and reached a peak in postoperative 1 d down gradually,after observing group,propagated / Cr and NAG / Cr in bi ~ 5 d after operation is lower than the control group（ P〈0. 05）. The Pearson correlation analysis showed that the plasma MDA each test time points of before anesthesia induction and postoperative respectively and propagated / Cr and NAG / Cr were positively correlated（ P〈0. 05）,while SOD respectively and propagated / Cr and NAG / Cr negatively correlated（ P〈0. 05）. Conclusion Hydrochloric right beauty holds the mi organism,which can obviously inhibit the oxidative stress reaction of patients with acute brain injury,reduce early kidney damage. The protecting perioperative renal function has a certain clinical significance.