亲体肝移植围术期右美托咪定的肾保护机制初探

Renal protection mechanism of dexmedetomidine in perioperative period of parental liver transplantation

目的探讨右美托咪定对肝移植术患儿肾损伤的影响。方法肝移植患儿40例,男女不限,年龄5~15个月,体质量5.5~10.0kg,ASA分级Ⅱ或Ⅲ级,分为两组(n=20):右美托咪定组(D组)和对照组(C组)。D组麻醉后输注右美托咪定1μg/kg,持续10min,然后以0.3μg·kg-1·h-1至术毕;C组给予同等容量的生理盐水。于术前即刻(T1)、门静脉阻断30min(T2)、门静脉开放l h(T3)、关腹结束(T4)和手术后24h(T5)抽中心静脉血样。ELISA检测血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-10和尿NGAL水平,比色方法测血清肌酐(Cr)和尿素氮(BUN)水平,并记录尿量。结果与C组比较,D组尿量增加,T3~T5时血清Cr、BUN水平降低(P<0.05),T2~T5时血清TNF-α和IL-6显著降低,血和尿NGAL降低,IL-10升高(P<0.05)。与C组比较,D组患儿T3~T5时血清Cr、BUN降低(P<0.05)。结论右美托咪定减轻肝移植术小儿的肾损伤。

Objective To evaluate the effects of dexmedetomidine on renal injury in infants undergoing pediatric parent liver transplantation.Methods 40 infants perioperative period of parental both sexes,aging 5-15 months,weighing 5.5-10.0 kg,ASA statusⅡorⅢ,scheduled for parent liver transplantation,were randomly divided into the control group(group C)and the dexmedetomidine group(group D)with 20 cases in each group.In group D,dexmedetomidine was continuously infused in a loading dose of 1μg/kg for 10 mins followed by a continuous infusion of 0.3μg·kg-1·h-1 until the end of operation.While in group C,normal saline was given at the same rate until the end of operation.At preoperative immediately phase(T 1),30 min of anhepatic phase(T 2),1 h of neohepatic phase(T 3),immediately after peritoneum closure(T 4)and 24 h after operation(T 5),blood samples from the central vein was collected for concentrations determination of tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-10,neutrophil gelatinase-associated lipocalin(NGAL)in serum and NGAL in urine by ELISA method,creatinine(Cr)and blood urea nitrogen(BUN)concentrations in serum by colorimetric assay.The urine volume was recorded during surgery.Results Compared with group C,the urine volume significantly increased in group D.Cr,BUN concentrations in serum decreased at T 3-T 5(P<0.05),concentrations of TNF-α,IL-6,NGAL in serum and NGAL in urine decreased at T 2-T 5(P<0.05).Concentration of IL-10 increased at T 2-T 5(P<0.05).Conclusion Dexmedetomidine can reduce renal injury in pediatric patients undergoing parental liver transplantation.