右美托咪定对体外循环心脏瓣膜置换患者术后肾功能的影响

目的 观察右美托咪定对体外循环下心脏瓣膜置换患者术后肾功能的影响.方法 50例风湿性心脏病 患者随机分为两组:右美托咪定组(D组,n=25)及对照组(C组,n=25).于术前(T0),术后24 h(T1)、48 h(T2)、72 h(T3)、96 h(T4)采集动脉血,7600全自动生化分析仪(日立)检查血清肌酐、血尿素氮(BUN )、血清胱抑素-C(Cys-C)、肾小球滤过率(GFR).结果 与T0比较,C组术后各时间点BUN、Cys-C值均明显 升高,而GFR降低,差异有统计学意义(P<0.05);从T2 时点后各时间点BUN、Cys-C逐渐下降,而GFR逐渐升高 ,与T0比较,差异有统计学意义(P<0.05),但T4时点各指标均未恢复到术前;与T0比较,血清肌酐术后各时 间点差异无统计学意义(P>0.05).D组血清肌酐 T2、T3、T4与T0比较均降低,差异有统计学意义(P<0.05) .两组间同时点各指标比较差异无统计学意义(P>0.05).结论 右美托咪定可促进体外循环下心脏瓣膜置换术 患者术后肾功能的恢复,对肾脏有一定的保护作用.

Effects of dexmedetomidine on postoperative renal function in patients undergoingcardiac valve replacement under cardiopulmonary bypass

Objective To investigate the effect of dexmedetomidine on renal function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass.Methods Fifty patients with rheumatic heart disease were randomly divided into the dexmedetomidine group (group D,n=25) and control group (group C,n=25).Arterial blood samples were collected before operation (T0),at postoperative 24 h (T1),48 h (T2),72 h (T3) and 96 h (T4) respectively.Serum Crea,blood urea nitrogen,cystatin C(Cys-C) and glomerular filtration rate(GFR) were detected by the Hitachi7600 automatic biochemical analyzer.Results Compared with T0,the levels of BUN and Cys-C at postoperative various time points were significant increased,while GFR was decreased,the differences were statistically significant (P<0.05).The levels of BUN and Cys-C started to gradually decrease and GFR started to increase from T2,the difference compared with that at T0 was statistically significant(P<0.05).But the levels of various indicators at T4 did not recovered to those before operation;compared with T0,serum Crea level had no statistical difference among postoperative various time points(P>0.05).Serum Crea level at T2-T4 in the group D was significantly lower than that at T0,the difference was statistically significant (P<0.05).There was no statistically significant difference in Crea,BUN,Cys-C and GFR between the two groups(P>0.05).Conclusion Dexmedetomidine can promote the recovery of postoperative renal function in the patients with cardiac valve replacement under cardiopulmonary bypass and has a certain protective effect on kidney.