右美托咪定对亲体肝移植患儿肾损伤标志物和炎症因子的影响

The effects of dexmedetomidine on kidney injury markers and inflammatory factors in pediatric patients with living donor liver transplantation

目的评估右美托咪定对亲体肝移植患儿肾损伤标志物和炎症因子的影响。方法择期行亲体肝移植患儿60例,性别不限,年龄5～15个月,体重5. 5～10. 0 kg,ASA分级Ⅱ或Ⅲ级,随机数字表法分为两组(n=30):右美托咪定组(D组)和对照组(C组)。D组于麻醉诱导之后进行气管插管机械通气,静脉输注右美托咪定负荷剂量1μg/kg,持续输液泵输注10 min,随后以0. 3μg/(kg·h)连续输注至手术结束; C组给予同等容量的生理盐水。于手术开始前即刻(T1)、门静脉阻断30 min(T2)、门静脉开放3 h(T3)和手术后24 h(T4)留取中心静脉血样和尿样,使用酶联免疫吸附法(ELISA)检测血清和尿中性粒细胞明胶酶脂质运载蛋白(NGAL),血清和尿胱抑素C(Cys C)以及血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6和IL-18浓度,并记录手术中尿量。结果与T1时比较,两组患儿T3～T4时血清NGAL和Cys C水平、T2～T4时血清TNF-α、IL-6和IL-18水平以及T2～T4时尿NGAL和Cys C水平升高(P <0. 05)。与C组比较,D组T3～T4时血清NGAL和Cys C水平、T2～T4时血清TNF-α、IL-6和IL-18水平以及T2～T4时尿NGAL和Cys C水平降低(P <0. 05)。结论右美托咪定能够降低肾损伤标志物和促炎症因子水平,从而减轻亲体肝移植患儿的肾功能损伤。

Objective To evaluate the effect of dexmedetomidine on NGAL and Cys-c in infants undergoing pediatric parental liver transplantation. Methods Sixty infants diagnosed with congenital biliary atresia,who were aged 5-15 months,weighing 5. 5-10 kg,with ASA Ⅱ or Ⅲ,and scheduled for parent liver transplantation,were randomly divided into control group( Group C) and dexmedetomidine group( Group D). After induction of anesthesia,the infants were intubated and mechanically ventilated. In Droup D,dexmedetomidine were continuously infused in a loading dose of1 μg/kg for 10 min followed by a continuous infusion of 0. 3 μg/( kg·h) until the end of operation;while placebo saline was given at the same rate until the end of operation in Group C. Blood and urine samples were collected immediately before skin incision( T1),at 30 min of anhepatic phase( T2),at 3 h of neohepatic phase( T3) and 24 h after operation( T4). Blood from the central vein was collected for determination of NGAL and Cys-c concentrations in serum using ELISA method. Concentrations of NGAL and Cys-c in urine were also determined by ELISA method. The urine volume was recorded during surgery. Results Compared with Group C,the urine volume was significantly increased in Group D.NGAL and Cys-c concentrations in serum were reduced at T3-T4 in both groups. Concentrations of NGAL and Cys-c in urine were reduced at T2-T4 in both group. Conclusion Dexmedetomidine can reduce the level of NGAL and Cys-c in pediatric patients undergoing living-related liver transplantation,inhibit renal injury induced by ischemia reperfusion.