不同剂量右美托咪定对妇科恶性肿瘤腹腔镜手术围术期肾功能的影响

Effect of Dexmedetomidine with Different Dosages on the Perioperative Renal Function in Patients Undergoing Laparoscopic Resection Surgery for Gynecologicmalignant Tumors

目的观察妇科恶性肿瘤腹腔镜手术中复合使用不同剂量的右美托咪定对围术期患者肾功能的影响。方法随机将患者分为对照组、研究组1、研究组2、研究组3。研究组于麻醉诱导时予0.4μg/(kg·h)负荷剂量右美托咪定静脉泵注10min后,分别以0.1μg/(kg·h)(研究组1)、0.2μg/(kg·h)(研究组2)、0.4μg/(kg·h)(研究组3)持续静脉泵注至术毕。观察各组患者术中不同时间点的心率、平均动脉压,尿量及人中性粒细胞明胶酶相关性脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)的改变。结果气腹120 min内尿量,研究组2和研究组3高于对照组及研究组1,差异有统计学意义(P<0.01),研究组3高于研究组2,差异有统计学意义(P<0.001);恢复期120 min内尿量,研究组3术后高于其余组,差异有统计学意义(P<0.05),其余各组间差异无统计学意义;研究组2和研究组3术后血浆NGAL水平低于研究组1和对照组,差异有统计学意义(P<0.001),而相应各两组间差异无统计学意义(P>0.5)。结论右美托咪定用于妇科恶性肿瘤腹腔镜手术增加术中及术后恢复期尿量,抑制NGAL的升高,并且该作用存在剂量依赖性。

Objective To explore the effect of different dose of dexmedetomidine on the perioperative renal function in patients undergoing resection surgery for gynecologic malignant tumors. Methods One hundred patients were assigned randomly into 4 groups： control group,study group 1,study group 2,and study group 3. Patients in the study groups were administered 0. 4μg /（ kg·h） of dexmedetomidine for 10 min during the anesthesia induction,and were infused intravenously with dexmedetomidine at 0. 1 μg /（ kg·h）（ study group 1）,0. 2 μg /（ kg·h）（ study group 2）,0. 4 μg /（ kg·h）（ study group 3） until the surgery completed. The values of HR,MAP,urine volume and neutrophil gelatinase associated lipocalin（ NGAL） at different time points were recorded. Results Urine volume within 120 min after the pneumoperitoneum inflation in study group 2 and study group 3 were higher than in study group 1 and control group,and that in study group 3 was higher than in study group 2（ P 〈0. 001）. Urine volume within 120 min after the surgery completeness in study group 3 was higher than in other three groups（ P 〈0. 05）,and no difference was found in urine volume among the control group,study group 1 and study group 2. NGAL in study group 2 and study group 3 were higher than in study group 1 and control group（ P 〈0. 001）,and there was no difference between study group2 and study group 3 as well as between study group 1 and control group. Conclusion In patients undergoing laparoscopic resection surgery for gynecologic malignant tumors,dexmedetomidine could improve the intraoperative hemodynamic response as well as perioperative renal function indicated by promoting urine production and alleviating the NGAL elevation caused by surgery,and this effect is in a manner of dose dependent.