右美托咪定对体外循环冠状动脉旁路移植术病人炎性反应和急性肾损伤的影响

张从利; 任丽; 梅玫; 刘娣; 施超; 李晓红

doi:10.13898/j.cnki.issn.1000-2200.2020.04.011

右美托咪定对体外循环冠状动脉旁路移植术病人炎性反应和急性肾损伤的影响

Effect of dexmedetomidine on the inflammatory response and acute kidney injury in patients treated with coronary artery bypass grafting under cardiopulmonary bypass

摘要

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1 μg/kg，随后以0.4 μg·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。

Abstract:
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(groupD) and control group(groupC) (30 cases in each group).After anesthesia induction, the group D were treated with 1 μg/kg of dexmedetomidine by intravenous pump for 10 minutes, and then 0.4 μg·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(T₀), end of cardiopulmonary bypass(T₁), end of operation(T₂), and after 6 h(T₃), 24 h(T₄), 48 h(T₅), 72 h(T₆) 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) and β₂-microglobulin(β₂-MG) in urine were detected in two groups.
Results Compared with T₀, the differences of SCr and CysC concentrations between two groups were not statistically significant from T₁ to T₆ (P>0.05).Compared with T₀, the levels of TNF-α, IL-6, CRP, BUN, NGAL, KIM-1 and β₂-MG increased, and the eGFR decreased in two groups from T₁ to T₆(P < 0.05 to P < 0.01).Compared with the group C, the concentrations of TNF-α and IL-6 in group D decreased at T₁ to T₆, the NGAL and KIM-1 levels decreased at T₂ to T₆, the CRP and β2-MG levels decreased at T₃ to T₆, the eGFR values increased at T₄ to T₆, and the BUN levels decreased at T₅ to T₆(P < 0.05 to P < 0.01).
Conclusions Dexmedetomidine can reduce the degree of inflammatory response caused by coronary artery bypass grafting under cardiopulmonary bypass, and has a protective effect on acute kidney injury.

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