Fischer Uwe M, Tossios Paschalis, Mehlhorn Uwe
Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany.
Curr Med Res Opin. 2005 Aug;21(8):1161-4. doi: 10.1185/030079905X53289.
Renal function impairment is a common complication in cardiac surgery patients. Because cardiopulmonary bypass and cardioplegic arrest are associated with formation of free radicals, which have been shown to impair various organs including the kidneys, radical scavenging may protect renal function. Therefore, the purpose of our study was to evaluate the impact of the radical scavenger N-acetylcysteine (NAC) versus placebo on peri-operative renal function in cardiac surgery patients.
We reanalyzed the data of our previous study in which 40 coronary artery surgery patients (66 +/- 9 [SD] years, 9 women and 31 men) with normal pre-operative renal function had been randomized in a double-blind fashion to receive either NAC (100 mg/kg into the cardiopulmonary bypass prime followed by infusion at 20 mg/kg/h; n = 20) or placebo (n = 20). We determined serum creatinine levels as an indicator for renal function pre- and at 1 day post-surgery as well as peri-operative urinary output and diuretic medication. Creatinine clearance was calculated according to Cockcroft and Gault.
Biometric and intra-operative patient data were similar between both groups. In the placebo group, serum creatinine increased from 93.1 +/- 35.4 micromol/L pre-operatively to 115.9 +/- 47.2 micromol/L on post-op day 1 (p < 0.001). In contrast, serum creatinine in the NAC group remained unchanged (92.3 +/- 31.3 micromol/L pre-op; 99.3 +/- 25.4 micromol/L on post-op day 1; p = 0.084). Accordingly, creatinine clearance decreased by 16.9 +/- 14.3 mL/min in the placebo group as compared to 7.5 +/- 17.7 mL/min in the NAC group (p = 0.039). Urinary output and diuretic medication were similar between NAC and placebo.
Our data suggest that free radical-scavenging using NAC protects renal function in patients subjected to cardiac surgery on cardiopulmonary bypass.
肾功能损害是心脏手术患者常见的并发症。由于体外循环和心脏停搏与自由基的形成有关，自由基已被证明会损害包括肾脏在内的各种器官，因此清除自由基可能会保护肾功能。因此，我们研究的目的是评估自由基清除剂N - 乙酰半胱氨酸（NAC）与安慰剂对心脏手术患者围手术期肾功能的影响。
我们重新分析了之前研究的数据，该研究中40例术前肾功能正常的冠状动脉手术患者（66±9[标准差]岁，9名女性和31名男性）被双盲随机分组，分别接受NAC（100mg/kg加入体外循环预充液，随后以20mg/kg/h输注；n = 20）或安慰剂（n = 20）。我们测定了术前及术后1天的血清肌酐水平作为肾功能指标，以及围手术期尿量和利尿剂使用情况。根据Cockcroft和Gault公式计算肌酐清除率。
两组患者的生物特征和术中数据相似。在安慰剂组，血清肌酐从术前的93.1±35.4μmol/L升至术后第1天的115.9±47.2μmol/L（p < 0.001）。相比之下，NAC组血清肌酐保持不变（术前92.3±31.3μmol/L；术后第1天99.3±25.4μmol/L；p = 0.084）。因此，安慰剂组肌酐清除率下降了16.9±14.3mL/min，而NAC组下降了7.5±17.7mL/min（p = 0.039）。NAC组和安慰剂组的尿量和利尿剂使用情况相似。
我们的数据表明，在接受体外循环心脏手术的患者中，使用NAC清除自由基可保护肾功能。
