右美托咪定对高血压脑出血开颅血肿清除术的老年患者术后肾功能的影响

Effect of dexmedetomidine on postoperative renal function in elderly patients with hypertensive cerebral hemorrhage undergoing removal of hematoma craniotomy

目的观察右美托咪定对高血压脑出血（HICH）行开颅血肿清除术的老年患者肾功能的影响。方法因HICH拟行开颅血肿清除术的老年患者60例，采用随机数字表法将患者分为两组（n=30）：对照组（C组）和右美托咪定组（D组）。两组均采用瑞芬太尼、丙泊酚靶控输注和静注咪达唑仑、舒芬太尼、顺式阿曲库铵麻醉诱导，气管插管后机械通气，靶控输注瑞芬太尼、丙泊酚及持续静脉输注顺式阿曲库铵维持麻醉。D组麻醉诱导后静脉输注右美托咪定0．2μg·kg-1·h-1至术毕，C组以等容量生理盐水替代。记录麻醉前5min、手术开始时、手术结束时以及术后l、4、12、24h（T0-6）分别检测血尿素氮、血肌酐、尿肾损伤分子-1（K1M-1）水平的变化，记录出血量、输血输液量和尿量。结果与Tn组内比较，T4、T5、T6的BUN、Cr明显增高（P〈0．05），L、R的KIM-1明显增高（P〈0．05）；与L组内比较，R的BUN、Cr、KIM-1明显降低（P〈0．05）。与C组相比，D组在T4、T5、T6的BUN、Cr明显降低（P〈0．05），T5、T6的KIM-1明显降低。结论因HICH拟行开颅血肿清除术的老年患者肾功能在围麻醉期减退，右美托咪定用于因HICH行开颅血肿清除术的老年患者的麻醉维持，对肾功能具有保护作用。

Objective To evaluate the effect of dexmedetomidine on postoperative renal function in elderly patients with hypertensive cerebral hemorrhage undergoing removal of hematoma craniotomy. Methods 60 elderly patients with hypertensive cerebral hemorrhage scheduled for removal of hematoma craniotomy were randomly divided into control group （group C） and dexmedetomidine group （group D） with 30 cases in each group. Anesthesia was induced with target-controlled infusion of remifentanyl and propofol and injection of midazolam, sufentanyl and cisatracurium, endotracheal intubation before mechanical ventilation. Anesthesia was maintained with target-controlled infusion of remifentanyl and propofol and intravenous injection of cisatracurium. In group D, dexmedetomidine 0.2μg/（kgoh） was infused during operation, while the equal volume of normal saline was given instead in group C. The levels of blood urea nitrogen, serum creatinine, urine kidney injury molecule-1 （KIM-1） were detected 5 minutes before anesthesia, at the beginning of operation, at the end of operation, postoperative 1 hour, 4 hours, 12 hours and 24 hours （T0.6）. Recorded the amount of blood loss, blood transfusion, infusion and urine output. Results BUN and Cr significantly increased at T4, T5, T6 compared with To （P〈0.05）, KIM-1 significantly increased at T5 and T6 （P〈0.05）. BUN, Cr and KIM-1 significantly decreased at T6 compared with Y5 （P〈0.05）. Compared with group C, BUN and Cr significantly decreased in group D at T4, T5 and T6 （P〈0.05）, KIM-1 significantly decreased at T5 and T6. Conclusion Postoperative renal function decreased in elderly patients with hypertensive cerebral hemorrhage undergoing removal ofhematoma craniotomy. Dexmedetomidine play a protective role in renal function of elderly patients with hypertensive cerebral hemorrhage undergoing removal of hematoma craniotomy.