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| 右美托咪定对失血性休克患者肾功能的影响 |
| Effects of dexmedetomidine on renal function in patients with hemorrhagic shock |
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| DOI： |
| 中文关键词: 失血性休克 右美托咪定 肾功能 促炎因子 |
| 英文关键词: Hemorrhagic shock Dexmedetomidine Renal function Proinflammatory cytokines |
| 基金项目:江西省卫计委科技计划项目 (20131048) |
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| 中文摘要: |
| 目的 探讨术中使用右美托咪定对失血性休克患者肾功能的影响。方法 选择本院拟行急诊全麻下手术治疗的失血性休克患者60例，男27例，女33例，年龄 18～69岁，ASA Ⅲ或Ⅳ级。将患者随机分为两组:右美托咪定组 (D组)和对照组 (C组)，每组30例。两组患者均在手术止血的同时积极进行容量复苏治疗，D组在麻醉诱导后切皮前给予右美托咪定 0.5 μg/kg，给药时间10 min，随后以0.4 μg·kg-1·h-1的速率静脉输注至术毕前30 min，C组给予等容量的生理盐水。分别于切皮前即刻 (T1)、术毕即刻 (T2)、术毕24 h (T3)、术毕72 h (T4)时采集静脉血样，检测血清肌酐 (Scr)和尿素氮 (BUN)浓度、中性粒细胞明胶酶相关脂质运载蛋白 (NGAL)和高迁移率族蛋白1 (HMGB1)含量，计算并比较T4时血清Scr浓度和T3时HMGB1含量较T1时的变化幅度 (ΔScr和ΔHMGB1)，并记录患者T1、T2时MAP、HR等血流动力学指标和剩余碱（BE）、乳酸（Lac）等动脉血气结果。结果 与T1时比较，T2时两组MAP、CVP和BE明显升高，HR和Lac明显降低 (P<0.05)，组间比较无统计学差异。与T1时比较，T3、T4时D组血清Scr浓度明显降低 (P<0.05); D组ΔScr明显小于C组 (P<0.05)。两组患者各时点血清BUN浓度差异无统计学意义。与T1时比较，T4时D组血清NGAL含量明显减少 (P<0.01); T4时D组血清NGAL含量明显少于C组 (P<0.05)。与T1时比较，T2时两组患者血清HMGB1含量明显减少 (P<0.05);T3时C组血清HMGB1含量明显增加 (P<0.01);T3时C组血清HMGB1含量明显多于D组 (P<0.05);C组ΔHMGB1明显大于D组 (P<0.05)。结论 右美托咪定可抑制缺血-再灌注后血清促炎因子HMGB1含量的增加，有利于失血性休克患者肾功能的恢复。 |
| 英文摘要: |
| Objective To investigate the effects of dexmedetomidine on renal function in patients with hemorrhagic shock undergoing emergency surgery. Methods Sixty patients (27 males, 33 females) with hemorrhagic shock, aged 18-69 years, ASA physical status Ⅲ or Ⅳ, required emergency surgery under general anesthesia, were randomized into two groups (n=30 each): dexmedetomidine group (group D) and control group (group C). The patients in group D receiving a loading dose of dexmedetomidine (0.5 μg/kg within 10 min) after the induction of anesthesia followed by a continuous infusion rate of 0.4 μg·kg-1·h-1 till 30 min before the end of surgery, while those in group C received equal volume of normal saline. Venous blood were obtained immediately before beginning of surgery (T1), immediately after surgery (T2), 24 h after surgery (T3) and 72 h after surgery (T4) for detecting the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN), the contents of neutrophil gelatinase-associated lipocalin (NGAL) and high mobility group box-1 (HMGB1). The range ability of the concentration of the serum Scr from T4 to T1 (ΔScr) and the content of the serum HMGB1 from T4 to T1 (ΔHMGB1) were also calculated and recorded. Hemodynamic index (including MAP, HR) and arterial blood gas results [including base excess (BE), lactic acid (Lac)] were recorded during surgery. Results Compared with T1, MAP, CVP and BE were increased, meanwhile, HR and Lac were decreased at T2, but there was no statistically significant difference between the two groups. No statistical difference was found in BUN at any time point between group D and group C. Compared with T1, Scr decreased in both groups at T2-T4. The ΔScr in group D was higher than that in group C at T4 (P<0.05). The content of serum NGAL at T4 in group D was significantly dropped when compared with T1 (P<0.01) and was lower than that in group C (P<0.05). Compared with T1, the content of serum HMGB1 was significantly decreased in both groups at T2 (P<0.05); the content of serum HMGB1 at T3 in group C was significantly increased and was higher than that in group D; the ΔHMGB1 in group C was higher than that in group D. Conclusion Hemorrhagic shock could induce acute kidney injury. Perioperative continuous infusion of dexmedetomidine facilitated renal function recovery after ischemia-reperfusion injury in patients with hemorrhagic shock through inhibiting the elevation of serum HMGB1. |
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