摘要
目的:探讨右美托咪定对体外循环冠状动脉(冠脉)旁路移植术病人炎性反应和急性肾损伤的影响。方法:择期行体外循环冠脉旁路移植术病人60例,随机分为右美托咪定组(D组)和对照组(C组),每组30例。D组麻醉诱导后经10 min静脉泵注右美托咪定1μg/kg,随后以0. 4μg·kg-1·h-1的泵注速度持续静脉泵注至术毕;C组以同样方法静脉泵注等容量0. 9%氯化钠溶液。分别于麻醉诱导前(T0)、体外循环结束(T1)、术毕(T2)、术后6 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)时采集颈内静脉血样并留取尿液样本,检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、血肌酐(SCr)、尿素氮(BUN)、血清胱抑素C(CysC)水平,估算各时间点肾小球滤过率(eGFR),并检测尿液中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)、β2-微球蛋白(β2-MG)水平。结果:与T0时比较,2组T1~T6时SCr及CysC浓度差异无统计学意义(P>0. 05);与T0时比较,2组T1~T6时TNF-α、IL-6、CRP、BUN、NGAL、KIM-1、β2-MG水平升高,eGFR降低(P <0. 05~P <0. 01);与C组比较,D组T1~T6时TNF-α、IL-6水平降低,T2~T6时NGAL、KIM-1水平下降,T3~T6时CRP、β2-MG水平降低,T4~T6时eGFR升高,T5~T6时BUN水平降低(P <0. 05~P <0. 01)。结论:右美托咪定能够降低体外循环冠脉旁路移植术引起的炎性反应程度,对急性肾损伤有一定保护作用。
Objective:To investigate the effects of dexmedetomidine on the inflammatory response and acute kidney injury in patients treated with coronary artery bypass grafting under cardiopulmonary bypass.Methods:Sixty patients scheduled by coronary artery bypass grafting under cardiopulmonary bypass were randomly divided into the dexmedetomidine group(group D)and control group(group C)(30 cases in each group).After anesthesia induction,the group D were treated with 1μg/kg of dexmedetomidine by intravenous pump for 10 minutes,and then 0.4μg·kg-1·h^-1 of dexmedetomidine by intravenous continuous pump until the end of operation.In group C,the same volume of 0.9%sodium chloride solution was pumped intravenously in the same way.The blood samples from internal jugular vein and urine samples were collected before induction of anesthesia(T 0),end of cardiopulmonary bypass(T 1),end of operation(T 2),and after 6 h(T 3),24 h(T 4),48 h(T 5),72 h(T 6)of operation.The serum concentrations of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),serum creatinine(SCr),blood urea nitrogen(BUN)and serum cystain C(CysC)were detected.The glomerular filtration rate(GFR)at each time-point were calculated,and the levels of neutrophils gelatinase-associated lipid delivery protein(NGAL),kidney injury molecule-1(KIM-1)andβ2-microglobulin(β2-MG)in urine were detected in two groups.Results:Compared with T 0,the differences of SCr and CysC concentrations between two groups were not statistically significant from T 1 to T 6(P>0.05).Compared with T 0,the levels of TNF-α,IL-6,CRP,BUN,NGAL,KIM-1 andβ2-MG increased,and the eGFR decreased in two groups from T 1 to T 6(P<0.05 to P<0.01).Compared with the group C,the concentrations of TNF-αand IL-6 in group D decreased at T 1 to T 6,the NGAL and KIM-1 levels decreased at T 2 to T 6,the CRP andβ2-MG levels decreased at T 3 to T 6,the eGFR values increased at T 4 to T 6,and the BUN levels decreased at T 5 to T 6(P<0.05 to P<0.01).Conclusions:Dexmedetomidine can reduce the degre
作者
张从利
任丽
梅玫
刘娣
施超
李晓红
ZHANG Cong-li;REN Li;MEI Mei;LIU Di;SHI Chao;LI Xiao-hong(Department of Anesthesiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004;School of Laboratory Medicine,Bengbu Medical College,Bengbu Anhui 233030,China;Department of Cardiac Surgery,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004)
出处
《蚌埠医学院学报》
CAS
2020年第4期464-468,共5页
Journal of Bengbu Medical College
基金
安徽省大学生创新训练项目(S201910367103)
蚌埠医学院自然科学基金重点项目(BYKY1861ZD)
蚌埠医学院科技发展基金项目(BYKY1828)。
关键词
右美托咪定
体外循环
冠状动脉旁路移植术
炎性反应
急性肾损伤
dexmedetomidine
cardiopulmonary bypass
coronary artery bypass grafting
inflammatory response
acute kidney injury
