Elmistekawy Elsayed, El-Serogy Hesham
Tanta University, Tanta, Egypt.
Semin Cardiothorac Vasc Anesth. 2009 Dec;13(4):231-7. doi: 10.1177/1089253209351598. Epub 2009 Nov 29.
This study evaluates whether dexamesathone in patients undergoing CABG using CPB results in better renal and pulmonary outcome.
100 patients were randomized to receive either placebo or dexamethasone (1 mg/ kg, at induction of anesthesia and 0.5 mg/kg 8 h later).
The differences regarding pulmonary parameters over times were significant in relation to measurements taken 10 minutes after intubation within groups; nevertheless, differences were significant between groups only at 12, 24 hours for A-a O(2) gradient, respiratory index, PaO(2)/FiO(2) ratio. Dexamethasone had no effect on extubation time. Creatinine clearance, urinary micro albumin excretion and (NAG) levels were comparable in both the groups. The dexamethasone treated patients were more likely to have hyperglycemia.
Dexamethasone offers no renal protective effect and the drug is associated with significant improvement in A-a O(2) gradient, respiratory index, PaO(2)/FiO( 2) at 12, 24 hours postoperatively and had no effect on extubation time and lung compliance.
本研究评估在接受体外循环冠状动脉旁路移植术(CABG)的患者中使用地塞米松是否能带来更好的肾脏和肺部预后。
100例患者被随机分为两组,分别接受安慰剂或地塞米松(诱导麻醉时1mg/kg,8小时后0.5mg/kg)。
组内插管后10分钟测量的肺参数随时间的差异具有显著性;然而,仅在12小时、24小时时,两组间肺泡-动脉氧分压差(A-a O₂)、呼吸指数、动脉血氧分压/吸入氧分数值(PaO₂/FiO₂)的差异具有显著性。地塞米松对拔管时间无影响。两组的肌酐清除率、尿微量白蛋白排泄率和N-乙酰-β-D-氨基葡萄糖苷酶(NAG)水平相当。接受地塞米松治疗的患者更易出现高血糖。
地塞米松无肾脏保护作用,该药物与术后12小时、24小时时肺泡-动脉氧分压差、呼吸指数、动脉血氧分压/吸入氧分数值的显著改善相关,且对拔管时间和肺顺应性无影响。