文章摘要
右美托咪定对脊柱手术患者围术期肝肾功能的影响
Effect of dexmedetomidine on liver and kidney function in patients undergoing spinal surgery
  
DOI：10.12089/jca.2018.03.001
中文关键词: 右美托咪定  肝功能  肾功能  脊柱手术
英文关键词: Dexmedetomidine  Liver function  Kidney function  Spinal surgery
基金项目:河北省卫计委资助课题(GL201629,ZL20140248);河北省优秀人才基金(361005)
作者单位E-mail
刘欣 050051,石家庄市,河北医科大学第三医院麻醉科  
赵爽 050051,石家庄市,河北医科大学第三医院麻醉科  
刘飞飞 050051,石家庄市,河北医科大学第三医院麻醉科  
李惠洲 050051,石家庄市,河北医科大学第三医院麻醉科  
刘朋 050051,石家庄市,河北医科大学第三医院麻醉科  
吴川 050051,石家庄市,河北医科大学第三医院麻醉科  
王秀丽 050051,石家庄市,河北医科大学第三医院麻醉科 wangxl301@aliyun.com 
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中文摘要:
      目的 观察右美托咪定对脊柱手术患者围术期肝肾功能的影响。方法 选择2016年12月至2017年5月全麻下行腰后路减压植骨融合内固定术的患者60例, 男31例, 女29例, 年龄49～78岁, BMI 19～30 kg/m2, ASA Ⅰ～Ⅲ 级, 采用随机数字表法分为两组(n=30): 右美托咪定组(D组)和对照组(C组), 分别在麻醉诱导前给予右美托咪定0.5～1.0 μg/kg和等容量生理盐水, 10 min内输完。术中D组持续泵入右美托咪定以0.2～0.5 μg·kg-1·h-1持续输注至手术结束前20 min;C组泵入等容量生理盐水至手术结束前20 min。分别于麻醉诱导前30 min(T0)、手术结束时(T1)和术后2 d(T2)抽取静脉血,采用ELISA法测定血清胱抑素C(CysC)、肌酐(Cr)、尿素(UREA)、谷丙转氨酶(ALT)、谷草转氨酶(AST),记录两组患者术中瑞芬太尼和丙泊酚用药量、住院时间和术后不良反应（术后低血压、心脑血管事件等）。结果 与T0时比较, T1时两组ALT、AST、Cr、UREA均明显降低(P＜0.05), T2时两组ALT、UREA, D组AST明显降低(P＜0.05);T1、T2时D组ALT、AST、UREA明显低于C组(P＜0.05), T1时D组Cr明显低于C组(P＜0.05);与C组比较, D组尿量明显增多(P＜0.05), 瑞芬太尼和丙泊酚总用量明显减少(P＜0.05)。两组住院时间和不良反应发生率差异无统计学意义。结论 脊柱手术患者全身麻醉过程中给予右美托咪定,明显减少术中麻醉药的用量, 有利于保护肝肾功能, 增加麻醉安全性。
英文摘要:
      Objective To observe the effect of dexmedetomidine on liver and kidney function in patients undergoing spinal surgery. Methods Sixty patients (31 males and 29 females, aged 49-78 years) of BMI 19-30 kg/m2 and ASA physical status Ⅰ-Ⅲ who underwent surgery for posterior lumbar interbodyfusion under general anesthesia from December 2016 to May 2017 in our hospital were selected as the research object. Patients were randomly divided into dexmedetomidine group (group D) and control group (group C)(n=30 each). In group D, DEX was infused over 10 min with the loading dose 0.5-1.0 μg/kg and followed by 0.2-0.5 μg·kg-1·h-1 as a maintenance dose. Group C received the same volume of saline. The blood samples were obtained from the patient at 30 min before anesthesia induction (T0), the end of the operation (T1) and 2 days after operation (T2) for recording monitoring index and determination of the levels of plasma CysC, Cr, UREA, ALT and AST. The dosages of remifentanil and propofol, hospital stay and the adverse reactions after the surgery (such as postoperative hypotension or cardio-cerebral vascular events) were compared between the two groups. Results Compared with T0, the levels of ALT, AST, Cr and UREA in the two groups were significantly reduced at T1 (P＜0.05), the levels of ALT, UREA of two groups and the levels of AST of group D were significantly reduced at T2(P＜0.05). The levels of ALT, AST, UREA at T1, T2 and the levels of Cr at T1 in group D were significantly lower than group C (P＜0.05). Compared with group C, the urine volume of group D increased significantly (P＜0.05), and there was a significant decrease in the dosage of remifentanil and propofol in group D (P＜0.05). There was no significant difference in the incidence of adverse reactions and hospitalization time between the two groups. Conclusion Spinal surgery patients during general anesthesia using dexmedetomidine, significantly reduce the amount of intraoperative anesthetic, protect liver and kidney function and increase the safety during anesthesia.
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