右美托咪定减少脊柱侧弯矫形术患者术后急性肾损伤的发生率

Application of dexmedetomidine decreases the incidence of acute kidney injury after scoliosis correction surgery

目的评价右美托咪定（右美）在脊柱侧弯矫形手术中的利尿功能是否能减少术后急性肾损伤的发生率。方法回顾2014年1～12月在全身麻醉下接受择期脊柱侧弯矫形手术的患者共85例的病例资料，按照是否使用右美分为右美组和对照组，比较两组患者的一般情况；术前，术后当天和术后第一天的血清肌酐以及急性肾损伤的发生率；术中的资料包括：手术时间、术中尿量、平均中心静脉压、输液量、输血液制品量、升压药使用量以及使用利尿药的患者例数。结果右美组患者术后当天以及术后第一天血清肌酐降低，手术后达到急性肾损伤诊断标准的患者数量减少（P〈0．05）；右美组患者术中尿量增加，平均中心静脉压降低，升压药使用量增加，输液量增加；利尿药使用例数下降（P〈0．05）。两组患者的手术时间以及输血制品的数量差异无统计学意义（P〉0．05）。结论在脊柱侧弯矫形手术中使用右美托咪定有明显利尿作用，减少术后24小时急性肾损伤的发生率。但是术中会出现中心静脉压下降，需要额外输液量甚至升压药。

Objective The aim of this study was to investigate the association between intraoperative dexmedetomidine infusion and the incidence of postoperative acute kidney injury（AKI） in patients undergoing spinal seoliosis correction surgery. Methods This was a retrospective study. We performed chart review of patients who underwent spinal scoliosis correction surgery during the 2014 calendar year in our hospital. A total of 85 patients met inclusion criteria, in which 45 patients received intravenous infusion of dexmedetomidine and 40 patients did not received dexmedetomidine. Available renal parameters including urine output and preoperatively and postoperatively serum creatinine levels were measured. The other data including central venous pressure （CVP） , usage of vasopressor, infusion crystalloid and colloid volume, diuretic agents, transfusion volume, incidence of postoperative AKI and the time of surgery were documented. Results Patients in the dexmedetomidine group had lower serum creatinine level and less incidence of postoperative AKI （P 〈 0.05）. Meanwhile, patients in the dexmedetomidine group showed a lower CVP, higher usage of vasopressors and infusion volumes （P 〈 0.05 ）. Furthermore, the use of diuretic agents was less and greater urine output during surgery （ P 〈 0.05 ） were observed in the dexmedetomidine group. The transfusion volume and length of surgery were not different between the two groups （ P 〉 0.05 ）. Conclusion Intraoperative dexmedetomidine application was associated with lower incidence of postoperative AKI.