脓毒症急性肾损伤患者使用右美托咪啶镇静对肾功能的保护作用

Protective Effect of Dexmedetomidine Sedation on Renal Function in Patients with Septic Acute Kidney Injury

目的:探讨使用右美托咪啶对脓毒症急性肾损伤(AKI)病人镇静过程中对病人肾功能产生的作用。方法:选择脓毒症AKI的病患54例,随机分组成观察组(A组)与对照组(B组),各27例,入组后实施镇静策略,包含镇痛、镇静、评估、每日中断镇静4个部分,在实施前(T0)、实施后第一日(T1)、第二日(T2)、第三日(T3)、第六日(T4)早上取静脉血,测量血肌酐(Scr)、胱抑素C (CysC)含量,取尿液测量中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)含量,同时记录镇静实施后4个时间点的肾脏顺序器官衰竭评估(SOFA)亚评分。结果:在组内比较中,和T0相比,A组在T2时,Scr水平显示明显降低(P 1、T2、T3时Scr水平显著下降(P 2、T3、T4时uNGAL明显降低,在T2、T3时血清CysC显著降低,在T4时肾脏SOFA亚评分降低(P < 0.05)。结论:使用右美托咪定镇静时可以降低脓毒症AKI病患Scr、CysC、uNGAL水平及肾的SOFA亚评分,可能具有保护和改善肾功能作用。

Objective: To investigate the effect of dexmedetomidine sedation strategy on renal function in pa-tients with kidney injury caused by sepsis. Methods: 54 patients with acute renal injury of sepsis were selected. They were randomly divided into dexmedetomidine group (experimental group, group D), Non-dexmedetomidine group (control group, group C), 27 cases in each group. The two groups were given a sedation strategy, including analgesia, sedation, evaluation, daily interruption of sedation. The blood samples and urine sample of the patients were taken immediately before sedation (T0), the first day after sedation (T1), the second day after sedation (T2), the third day after sedation (T3), the sixth day after sedation (T4), to determine the level of Scr, CysC, and urine the lev-el of NGAL, compare the changes in the renal sequential organ failure assessment (SOFA) subscores from the baseline within five points in times after randomization between groups. Result: Within the data of intra-group, compared with T0 time point, the levels of serum Scr in group D significantly decreased at T2 time point (P 0.05). Within the data of inter-group, compared with group C, the level of serum Scr in group D significantly decreased at T1, T2 and T3 time point (P 2 , T3 and T4 time point (P 2 and T3 time point (P < 0.05). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the D group at T4 time point (P < 0.05). Conclusion: A sedation strategy with dexmedetomidine can effec-tively decrease the levels of serum Scr and CysC and unire NGAL for AKI patients. A sedation strate-gy with dexmedetomidine is associated with improving renal function among patients with sepsis.