右美托咪定对肝移植手术中肾功能的影响

The effect of dexmedetomidine on renal functions during the anesthesia of liver transplantation patients

目的评价右美托咪定对肝移植术中患者肾功能的影响。方法选择本院拟行原位肝移植术患者40例,男31例,女9例,年龄40-60岁,ASAⅡ或Ⅲ级。随机分为两组：右美托咪定组（D组）和生理盐水组（C组）,每组20例。D组患者诱导前以右美托咪定负荷剂量0.5μg/kg,10min内泵注,随后以0.4μg·kg^-1·h^-1持续泵注直至手术结束;C组患者按同等方案泵注生理盐水。两组患者在麻醉诱导后（T1）、无肝期30min（T2）、新肝期30min（T3）、新肝期6h（T4）、术后24h（T5）及术后1周（T6）抽取中心静脉血检测胱抑素C、内生肌酐清除率、血尿素氮、血肌酐,收集尿液检测尿微量蛋白、尿红细胞,记录术中升压药和利尿剂的使用量;记录术中出血量、液体输注量、尿量和输血量（包括悬浮红细胞、新鲜冰冻血浆和血小板）。结果与T1时比较,T3、T4时D组胱抑素C、血尿素氮、血肌酐明显升高,内生肌酐清除率明显降低（P〈0.05）,T3-T5时D组尿微量蛋白明显升高（P〈0.05）,T3-T5时C组胱抑素C、血尿素氮、血肌酐、尿微量蛋白明显升高,内生肌酐清除率明显降低（P〈0.05）;D组T3-T5时的胱抑素C、血尿素氮、血肌酐明显低于C组（P〈0.05）;D组T4、T5时的内生肌酐清除率明显高于,尿微量蛋白明显低于C组（P〈0.05）;围术期D组多巴胺、去甲肾上腺素、去氧肾上腺素的使用量和尿量明显多于C组,呋塞米的使用量明显少于C组（P〈0.05）。两组术中出血量、输液量及输血量（悬浮红细胞、新鲜冰冻血浆、血小板）差异无统计学意义。结论肝移植围术期持续泵注右美托咪定虽然会增加升压药的使用,但能有效减轻术中急性肾损伤,减少利尿剂的使用。

Objective To evaluate the effect of dexmedetomidine on renal functions during the anesthesia of liver transplantation patients.Methods Forty patients（male 31 cases,female 9cases,aged 40-60 years,ASA gradeⅡ orⅢ）received liver transplantation were randomly divided into two groups（n=20）：dexmedetomidine group（group D）and normal saline group（group C）.Patients in the group D received a loading dose of dexmedetomidine（0.5μg/kg within 10min）and a continuous infusion of dexmedetomidine（0.4μg·kg^-1·h^-1）until the end of surgery,while patients in group C received saline.Central venous blood and urine were collected after induction of anesthesia（T1）,the anhepatic phase of liver 30min（T2）,new liver stage 30min（T3）,new liver stage 6h（T4）,postoperative 24h（T5）and postoperative 1week（T6）to detect the serum cystatin C,endogenous creatinine clearance rate,blood urea nitrogen,blood creatinine,urinary NAG enzyme,urinary albumin,and red blood cells.The use of vasopressors and diuretics,blood loss,fluid,urine,and blood transfusion（including RBC,fresh frozen plasma,and platelets）were all recorded.Results Compared with T1,serum cystatin C,blood urea nitrogen,serum creatinine of group D increased significantly and endogenous creatinine clearance rate reduced significantly at T3,T4（P〈0.05）.Microalbuminuria increased at T3-T5（P〈0.05）.Serum cystatin C,blood urea nitrogen,serum creatinine of group C increased significantly and endogenous creatinine clearance rate reduced significantly（P〈0.05）.Compared with group C,serum cystatin C,blood urea nitrogen,serum creatinine of group D reduced significantly at T3-T5 and endogenous creatinine clearance rate increased（P〈0.05）.Microalbuminuria reduced significantly at T4,T5（P〈0.05）.Perioperative use of diuretics in group D patients was less than that in group C,but the use of vasopressors in group D patients was more than that in group C（P〈0.05）.Urine volume in group D was more than that in group C（P〈0.05）.There was no difference in perioperative blood loss,fluid, and blood transfusion between two groups.Conclusion Perioperative continuous infusion of dexmedetomidine might effectively alleviate acute kidney injury during operation and decrease the use of diuretics.