羟考酮对心脏瓣膜置换术后患者肾功能及炎症因子水平的影响

Effects of oxycodone on renal function and serum inflammatory factors after cardiac valve replacement

目的探讨羟考酮对心脏瓣膜置换术后患者肾功能及血清炎症因子水平的影响。方法纳入心脏瓣膜置换术患者120例作为研究对象,采用随机数字表法分为对照组(C组,n=26),羟考酮低剂量组(Q1组,n=29)、羟考酮中剂量组(Q2组,n=32)和羟考酮高剂量组(Q3组,n=33)。Q1、Q2和Q3组于麻醉诱导前5 min分别给予0.05、0.10和0.15 mg/kg羟考酮静脉注射,C组给予等量生理盐水输注。检测并比较4组患者术后即刻,24、48、72和96 h血清肌酐及白细胞介素6(IL-6)、IL-17、肿瘤坏死因子α(TNF-α)的表达水平,评估4组患者急性肾损伤(AKI)发生率的差异。结果术后72、96 h,Q1、Q2和Q3组患者血清肌酐水平显著低于C组,差异有统计学意义(P<0.05);术后96 h,Q3组患者血清肌酐水平显著低于Q2组和Q1组患者,Q2组患者血清肌酐水平显著低于Q1组患者,差异均有统计学意义(P<0.05);4组患者术后24、48和96 h,Q3组患者血清炎症因子水平均显著低于C组,差异有统计学意义(P<0.05);术后96 h,Q3组同Q2组和Q1组相比,Q2组和Q1组相比,IL-6、IL-17、TNF-α水平均显著降低,差异均有统计学意义(P<0.05)。Q3组与C组比较,AKI发生率显著降低,差异有统计学意义(χ^2=11.746,P<0.05)。结论羟考酮预处理能显著降低心脏瓣膜置换术患者术后AKI的发生率,缓解全身炎症状态,其中以0.15 mg/kg羟考酮预处理效果最好。

Objective To investigate the effects of oxycodone on renal function and serum inflammatory factors after cardiac valve replacement.Methods A total of 120 patients with cardiac valve replacement in Nanyang Central Hospital were included and divided into control group(group C,n=26),low(group Q1,n=29),middle(group Q2,n=32)and high dose of oxycodone(group Q3,n=33)in accordance with the random number table.Q1,Q2 and Q3 groups patients were given oxycodone intravenous injection of 0.05,0.10 and 0.15 mg/kg over 5 minutes before induction of anesthesia,while the equal volume of normal saline was given in C group.The levels of creatinine and serum inflammatory factors such as IL-6,IL-17 and TNF-αwere detected and compared,and the incidence and severity of acute renal injury among the four groups were evaluated immediately,24,48,72 and 96 h after operation in the four groups.Results The serum creatinine levels in group Q1,Q2 and Q3 were significantly lower than those in group C at 72 and 96 h after operation(P<0.05).The serum creatinine level in group Q3 was significantly lower than that in group Q1 and Q2 at 96 h after operation and the serum creatinine levels in group group Q2 was significant lower when compared to Q1 group(P<0.05).At 24,48 and 96 h after operation,the levels of serum inflammatory factors in Q3 group were significantly lower than those in group C(P<0.05).At 96 h after operation,compared with group Q2 and Q1,the levels of serum inflammatory factors in Q3 group were significantly lower in Q2 group(P<0.05).Besides,when compared with Q1 group,the levels of serum inflammatory factors were significantly lower(P<0.05).The incidence of AKI in Q3 group was significantly lower than that in C group,and the difference was statistically significant(χ^2=11.746,P<0.05).Conclusion Oxycodone pretreatment may by significantly reduce the incidence of acute renal injury in patients with cardiac valve replacement and can also can alleviate systemic inflammation status with a most optimum dose of0.15 mg/kg.