右美托咪定预充对体外循环下心脏手术患者肾功能的影响

Effect of Dexmedetomidine Prefilled on Renal Function in Patients undergoing Cardiac Surgery under Cardiopulmonary Bypass

目的探讨体外循环过程中,预充右美托咪定对心脏手术患者肾功能的影响。方法 2014年1月～2017年1月于天津市第一中心医院择期行CPB心脏直视手术患者86例,随机分为对照组(C组)与观察组(D组),各43例。D组预充液加右美托咪定注射液1μg/kg,C组预充液加等量生理盐水。在转机前(T_0),转机后10 min(T_1),升主动脉阻断后10 min(T_2),升主动脉开放后10 min(T_3),CPB结束后(T_4)抽取血样检测NGAL、Cys-C和β2-MG;在各时间点经食道超声监测两组患者肾动脉内径、肾动脉平均血流速度和肾血流量。结果 (1)与T_0比较,T_3、T_4时两组患者NGAL均升高,差异有统计学意义(P<0.05);T_4时C组NGAL水平高于D组,差异有统计学意义(P<0.05);(2)与T_0比较,T_3、T_4时两组患者Cys-C均升高,差异有统计学意义(P<0.05);但两组间Cys-C水平各时间点比较,差异无统计学意义(P>0.05);(3)与T_0比较,T_2、T_3和T_4两组β2-MG均升高,差异有统计学意义(P<0.05);且T_2、T_3和T_4时,D组患者β2-MG水平均低于C组,差异有统计学意义(P<0.05);(4)D组患者动脉平均血流速度在T_3、T_4时均高于T_0时,差异有统计学意义(P<0.05),肾血流量在T_2、T_3和T_4时均高于T_0时,差异有统计学意义(P<0.05);T_3、T_4时刻,D组患者肾动脉平均血流速度均高于C组,差异有统计学意义(P<0.05); T_2、T_3和T_4时刻,D组患者肾血流量均高于C组,差异有统计学意义(P<0.05)。结论右美托咪定对CPB下心脏手术围术期肾功能具有保护作用,可有效抑制肾脏损伤,维持肾血流动力学稳定,提高围术期安全性。

Objective To investigate the effect of pre-filled dexmedetomidine on renal function in patients undergoing cardiac surgery during cardiopulmonary bypass.Methods From January 2014 to January 2017,86 patients with CPB open heart surgery were selected in Tianjin First Central Hospital.They were randomly divided into control group （group C）and observation group （group D）,43 cases each.Group D prefilled plus dexmedetomidine injection 1 μg/kg,group C prefilled with the same amount of normal saline.Before the transfer（To）,10 min after the transfer（T1）,10 min after the ascending aorta（T2）,10 min after the ascending aorta（T3）,and after the end of the CPB （T4）,the blood samples were taken to detect NGAL,Cys-C and 132-MG;renal artery diameter, renal artery mean blood flow velocity and renal blood flow were monitored by esophageal ultrasound at each time point.Results ①Compared with To, NGAL was increased in both groups at T3 and T4,the difference was statistically significant（P〈0.05）.The level of NGAL in group C was higher than that in group D at T4,the difference was statistically significant（P〈0.05）.②Compared with To, Cys-C was increased in both groups at T3 and T4,the difference was statistically significant（P〈0.05）.However,there was no significant difference in Cys-C levels between the two groups（P〉0.05）.③Compared with To,132-MG increased in T2,T3 and T4 groups,the difference was statistically significant（P〈0.05）;and in T2,T3 and T4,the 132-MG level in group D was lower than that in group C,the difference was statistically significant （P〈0.05）; ④The mean blood flow velocity of patients in group D was higher than To at T3 and T4,the difference was statistically significant（P〈0.05）,and the renal blood flow was higher than To at T2,T3 and T4,the difference was statistically significant （P〈0.05）;at T3 and T4,the mean blood flow velocity of renal artery in group D was higher than that in group C,the difference was statistically significant（P〈0.05）.At T2,T3 and T4,the renal blood flow of group D was higher than that of group C,the difference was statistically significant （P〈0.05）.Conclusion Dexmedetomidine has a protective effect on perioperative renal function in patients undergoing cardiac surgery under CPB,which can effectively inhibit kidney damage,maintain renal hemodynamic stability,and improve perioperative safety.