右美托咪定对小儿先天性心脏病术后急性肾功能损伤的预防效应

刘海渊; 高晴云; 李艳丽; 汪洋; 陈嘉怡; 方敏; 陶静; 杨晓凡; 张成鑫; 葛圣林

doi:10.12125/j.chj.201809054

右美托咪定对小儿先天性心脏病术后急性肾功能损伤的预防效应

Protective effect of dexmedetomidine against acute renal injury after pediatric heart surgery

摘要

摘要:
目的了解右美托咪定对小儿先天性心脏病术后急性肾功能损伤的预防效应。
方法 30例确诊房间隔或室间隔缺损的患儿参与研究。患儿随机分别接受生理盐水(对照组，n = 15)和右美托咪定(试药组，n = 15)给药处理，给药时间从麻醉诱导至体外循环结束。分别于术前(T0)，麻醉诱导后10 min(T1)，体外循环结束后5 min(T2)，T2点后2 h(T3)，术后第1天(POD1)和术后第2天(POD2)测定血肌酐水平(SCr)并计算肾小球滤过率估值(eGFR)。急性肾功能损伤(AKI)定义为SCr绝对值增加超过3 mg/L或是上升幅度超过50%。
结果对比对照组，试药组中围术期AKI发病率显著降低(P < 0.05)。T2和T3点测定对照组中eGFR水平较试药组显著降低(P < 0.05)。
结论术中给药右美托咪定有助于降低AKI的发病率并有效防止体外循环结束后eGFR水平的下降。

Abstract:
AIM To explore the renal protective effects of dexmedetomidine after pediatric heart surgery.
METHODS A total of 30 pediatric patients (1-6 years) with atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n = 15) or dexmedetomidine (a bolus dose of 0.5 mg/kg and then an infusion of 0.5 mg/kg/h) (treatment group, n = 15) from anesthesia induction to the end of cardiopulmonary bypass. Serum creatinine (SCr) was measured before surgery (T0), 10 minutes after anesthesia induction (T1), 5 minutes after cardiopulmonary bypass weaning (T2), 2 hours after T2 (T3), and after postoperative day 1 (POD1) and postoperative day 2 (POD2) and estimated glomerular filtration rates (eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3. Acute kidney injury (AKI) was de.ned as an absolute increase in SCr of ≥ 0.3 mg/dL or a percent increase in SCr of ≥50%.
RESULTS The incidence of AKI during the perioperative period was significantly higher in the control group than in the treatment group (P < 0.05). eGFR was significantly lower in the control group than in the treatment group at T2 and T3 (P < 0.05).
CONCLUSION Intraoperative infusion of dexmedetomidine may reduce the incidence of AKI and suppress post-bypass eGFR decline.

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