摘要目的 评价右美托咪定对体外循环下瓣膜置换术后患者急性肾损伤的影响.方法 择期拟行心脏瓣膜置换术的风湿性心脏病患者100例,性别不限,年龄32 ～ 64岁,体重46 ～ 75 kg,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=50):对照组(C组)和右美托咪定组(D组).D组于常规麻醉诱导前经10 min静脉输注右美托咪定lμg/kg负荷量,随后以0.4 μg·kg-1·h-1的速率输注至术后24 h,C组静脉输注等容量生理盐水.记录患者术后48 h内每小时尿量,于术后6、12、24、36和48 h时取肘正中静脉血样,测定血清肌酐水平.根据尿量及血清肌酐水平判断急性肾损伤的发生情况及严重程度.结果 与C组比较,D组术后48 h内急性肾损伤的发生率及严重程度明显降低(P＜0.05).结论 诱导前经10 min静脉输注右美托咪定1μg/kg负荷量,随后以0.4 μg·kg-1·h-1的速率输注至术后24 h可降低体外循环下心脏瓣膜置换术后患者急性肾损伤的发生,且减轻其严重程度.

abstractsObjective To evaluate the effect of dexmedetomidine on acute kidney injury after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods One hundred patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 46-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =50 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation in group D,while the equal volume of normal saline was given in group C.The urine output per hour during the postoperative 48 h period was recorded.At 6,12,24,36 and 48 h after operation,blood samples were collected from the median cubital vein for determination of serum creatinine levels.The development and severity of acute kidney injury were determined according to the urine output and serum creatinine level.Results Compared with group C,the incidence and severity of acute kidney injury were significantly decreased in the postoperative 48 h period in group D (P＜0.05).Conclusion Dexmedetomidine infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation can reduce the development and severity of acute kidney injury after cardiac valve replacement with CPB in patients.