舒芬太尼预处理对非体外循环冠脉搭桥术后患者肾功能的影响

Renal Protective Effect of Sufentanil Preconditioning on Patients After Off-Pump Coronary Artery Bypass Grafting

目的:研究舒芬太尼预处理对非体外循环冠脉搭桥术(OPCAPG)后患者的肾脏保护作用。方法:选择2018年1月至2020年12月期间在我院接受OPCABG的患者作为研究对象,随机分为低剂量组、中剂量组、高剂量组,分别在前降支动脉再通前5min给予0.5μg/kg、1.0μg/kg、1.5μg/kg舒芬太尼预处理。比较三组患者手术情况及围手术期肾功能指标、炎症因子、氧化应激指标的差异。结果:三组间手术时间、气管拔管时间、ICU停留时间、术后在院时间无差异(P>0.05);手术后24h,低剂量组Scr、BUN、UACR水平与手术前比较明显升高(P<0.05),中剂量组及高剂量组Scr、BUN、UACR水平与手术前比较无差异(P>0.05),三组的TNF-α、IL-1β、IL-6、MDA、8-OHdG水平与手术前比较明显升高(P<0.05)、SOD、GSH水平与手术前比较明显降低(P<0.05)且中剂量组及高剂量组Scr、BUN、UACR、TNF-α、IL-1β、IL-6、MDA、8-OHdG水平低于低剂量组,SOD、GSH水平高于低剂量组(P<0.05)。结论:1.0μg/kg、1.5μg/kg舒芬太尼预处理通过抑制炎症反应及氧化应激对OPCAPG后的肾功能具有保护作用。

Objective:To study the renal protective effect of sufentanil preconditioning on patients after off-pump coronary artery bypass grafting(OPCAPG).Methods:Patients who received OPCABG in our hospital from January 2018 to December 2020 were randomly divided into low-dose group,medium-dose group and high-dose group.0.5μg/kg,1.0μg/kg and 1.5μg/kg sufentanil was given 5 minutes before the recanalization of anterior descending artery.The differences of surgery conditional,renal function,inflammatory cytokines and oxidative stress indexes were compared among the three groups.Results:There was no difference in operation time,tracheal extubation time,ICU stay and postoperative hospital stay among the three groups(P>0.05);24 hours after operation,Scr,BUN and UACR levels in the low-dose group were significantly higher than those before operation(P<0.05);Scr,BUN and UACR levels in the medium dose group and high dose group were not different from those before operation(P>0.05);TNF-α,IL-1β,IL-6,MDA and 8-OHdG levels in the three groups were significantly higher than those before operation(P<0.05);SOD,GSH levels were significantly lower than those before operation(P<0.05)and TNF-α,IL-1β,IL-6,MDA and 8-OHdG levels of middle dose group and high dose group were lower than those in low dose group,while SOD and GSH levels were higher than those in low dose group(P<0.05).Conclusion:1.0μg/kg and 1.5μg/kg sufentanil pretreatment has protective effect on renal function after OPCAPG.Inhibition of inflammatory response and oxidative stress is the related molecular mechanism.