摘要
目的观察右美托咪定(DEX)对腹腔镜肾部分切除术(LPN)患者术后远期肾功能的保护作用。方法选取2021年5月至2022年12月安徽医科大学第二附属医院择期行LPN患者80例,根据随机对照表法将患者随机分为右美托咪定组和对照组,每组40例。右美托咪定组在肾动脉阻断前30 min给予DEX负荷量0.6 mg/kg,之后改为维持剂量0.5μg/(kg·h)并持续到手术结束前30 min。对照组静脉泵注相同剂量和时间的生理盐水。记录患者麻醉诱导前(T_(0))、插管即刻(T_(1))、肾动脉阻断即刻(T_(2))、肾动脉开放即刻(T_(3))和拔管即刻(T_(4))的平均动脉压(MAP)和心率(HR)。监测患者术前以及术后1、6个月^(99m)Tc-DTPA肾小球滤过率(GFR)、血清胱抑素C(Cys-C)和血清肌酐(SCr),并根据公式计算出基于SCr的估计GFR(eGFRcr)、基于SCr和Cys-C的估计GFR(eGFRcr-cys)和基于Cys-C的估计GFR(eGFRcys)。观察患者术前以及术后24 h和48 h血清中性粒细胞明胶酶相关载脂蛋白(NGAL)和尿肾损伤分子-1(KIM-1)含量。结果T_(1)、T_(4)时,右美托咪定组MAP低于对照组(P<0.05),T_(2)时,MAP高于对照组(P<0.05);T_(1)时,右美托咪定组HR低于对照组(P<0.05)。术后24 h和48 h,右美托咪定组血清NGAL和尿KIM-1低于对照组(P<0.05)。术后1、6个月,右美托咪定组手术侧^(99m)Tc-DTPA GFR值高于对照组(P<0.05),而两组对侧^(99m)Tc-DTPA GFR和总^(99m)Tc-DTPA GFR值比较,差异无统计学意义(P>0.05)。术后1、6个月,右美托咪定组eGFRcr-cys和eGFRcys值高于对照组(P<0.05),但两组eGFRcr值比较,差异无统计学意义(P>0.05)。结论DEX可对LPN术后远期肾功能产生保护作用,是防治LPN术后慢性肾脏病发生和发展的潜在治疗药物。
Objective To observe the protective effect of dexmedetomidine(DEX)on the long-term renal function of patients undergoing laparoscopic partial nephrectomy(LPN).Methods A total of 80 patients who underwent elective LPN at the Second Affiliated Hospital of Anhui Medical University from May 2021 to December 2022 were selected.The patients were randomly divided into the DEX pretreatment group(DEX group)and control group,with 40 cases in each group.In DEX group,a loading dose(0.6 mg/kg)of DEX was administered 30 min before renal artery occlusion,followed by a maintenance dose of 0.5μg/(kg·h),which was continued until 30 min before the end of surgery.Control group received an equal volume and time of normal saline intravenously.The mean arterial pressure(MAP)and heart rate(HR)of the patients were recorded at the following time points:before anesthesia induction(T_(0)),immediately after intubation(T_(1)),immediately after renal artery occlusion(T_(2)),immediately after renal artery reperfusion(T_(3)),and immediately after extubation(T_(4)).The preoperative,1-month postoperative,and 6-month postoperative ^(99m)Tc-DTPA glomerular filtration rate(GFR),serum cystatin C(Cys-C),and serum creatinine(SCr)levels were observed;the estimated GFR(eGFR)was calculated,including eGFRcr,eGFRcr-cys,and eGFRcys.The serum neutrophil gelatinase-associated lipocalin(NGAL)and urinary kidney injury molecule-1(KIM-1)levels were measured before and aT_(2)4 h and 48 h after operation.Results Compared with control group,DEX group had a significant decrease in MAP at T_(1)and T_(4)(P<0.05),and a significant increase in MAP at T_(2)(P<0.05).The level of HR in DEX group was lower that in control group at T_(1)(P<0.05).Compared with control group,the DEX group had lower serum NGAL and urinary KIM-1 levels aT_(2)4 h and 48 h after operation(P<0.05).The GFR on the surgical side and the levels of eGFRcr-cys and eGFRcys in DEX group were higher than that in control group aT_(1)month and 6 months after operation(P<0.05),but there was no significant difference in the contralateral GFR and total GFR and the level of eGFRcr between the two groups(P>0.05).Conclusion DEX can alleviate long-term renal function damage after LPN,and it is a potential therapeutic drug for preventing and treating chronic kidney disease.
作者
蒋玲玲
陈齐
宋永生
刘晓芬
张杨
张野
Jiang Lingling;Chen Qi;Song Yongsheng;Liu Xiaofen;Zhang Yang;Zhang Ye(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital of Anhui Medical University,Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes,Anhui Medical University,Hefei 230601,China)
出处
《实用药物与临床》
CAS
2024年第3期192-196,共5页
Practical Pharmacy and Clinical Remedies
基金
安徽医科大学校科研基金资助项目(2021xkj167)。
关键词
右美托咪定
腹腔镜肾部分切除术
缺血再灌注损伤
慢性肾脏病
Dexmedetomidine
Laparoscopic partial nephrectomy
Ischemia-reperfusion injury
Chronic kidney disease
