大剂量芬氟拉明可降低小儿心脏手术后中性粒细胞明胶酶相关脂质运载蛋白和胱抑素 C 的水平。
High-dose fenoldopam reduces postoperative neutrophil gelatinase-associated lipocaline and cystatin C levels in pediatric cardiac surgery.
机构信息
Pediatric Cardiac Anesthesia/Intensive Care Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, Piazza S, Onofrio 4, 00165, Rome, Italy.
出版信息
Crit Care. 2011 Jun 29;15(3):R160. doi: 10.1186/cc10295.
INTRODUCTION
The aim of the study was to evaluate the effects of high-dose fenoldopam, a selective dopamine-1 receptor, on renal function and organ perfusion during cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD).
METHODS
A prospective single-center randomized double-blind controlled trial was conducted in a pediatric cardiac surgery department. We randomized infants younger than 1 year with CHD and biventricular anatomy (with exclusion of isolated ventricular and atrial septal defect) to receive blindly a continuous infusion of fenoldopam at 1 μg/kg/min or placebo during CPB. Perioperative urinary and plasma levels of neutrophil gelatinase-associated lipocaline (NGAL), cystatin C (CysC), and creatinine were measured to assess renal injury after CPB.
RESULTS
We enrolled 80 patients: 40 received fenoldopam (group F) during CPB, and 40 received placebo (group P). A significant increase of urinary NGAL and CysC levels from baseline to intensive care unit (ICU) admission followed by restoration of normal values after 12 hours was observed in both groups. However, urinary NGAL and CysC values were significantly reduced at the end of surgery and 12 hours after ICU admission (uNGAL only) in group F compared with group P (P = 0.025 and 0.039, respectively). Plasma NGAL and CysC tended to increase from baseline to ICU admission in both groups, but they were not significantly different between the two groups. No differences were observed on urinary and plasma creatinine levels and on urine output between the two groups. Acute kidney injury (AKI) incidence in the postoperative period, as indicated by pRIFLE classification (pediatric score indicating Risk, Injury, Failure, Loss of function, and End-stage kidney disease level of renal damage) was 50% in group F and 72% in group P (P = 0.08; odds ratio (OR), 0.38; 95% confidence interval (CI), 0.14 to 1.02). A significant reduction in diuretics (furosemide) and vasodilators (phentolamine) administration was observed in group F (P = 0.0085; OR, 0.22; 95% CI, 0.07 to 0.7).
CONCLUSIONS
The treatment with high-dose fenoldopam during CPB in pediatric patients undergoing cardiac surgery for CHD with biventricular anatomy significantly decreased urinary levels of NGAL and CysC and reduced the use of diuretics and vasodilators during CPB.
TRIAL REGISTRATION
Clinical Trial.Gov NCT00982527.
简介
本研究旨在评估高剂量芬多卡胺（一种选择性多巴胺-1 受体激动剂）对伴有双心室解剖结构的先天性心脏病（CHD）婴儿体外循环（CPB）期间肾功能和器官灌注的影响。
方法
在儿科心脏外科部门进行了一项前瞻性、单中心、随机、双盲对照试验。我们将年龄小于 1 岁且伴有 CHD 和双心室解剖结构（不包括孤立的室间隔和房间隔缺损）的婴儿随机分为两组，在 CPB 期间分别接受芬多卡胺 1μg/kg/min 或安慰剂的持续输注。测量 CPB 后围手术期尿液和血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素 C（CysC）和肌酐水平，以评估 CPB 后的肾损伤。
结果
共纳入 80 例患者：40 例在 CPB 期间接受芬多卡胺（F 组），40 例接受安慰剂（P 组）。两组患者从基线到入住重症监护病房（ICU）时的尿液 NGAL 和 CysC 水平均显著升高，随后在 12 小时后恢复正常。然而，与 P 组相比，F 组在手术结束时和入住 ICU 后 12 小时时尿液 NGAL 和 CysC 值显著降低（uNGAL 分别为 P = 0.025 和 0.039）。两组患者的血浆 NGAL 和 CysC 水平均从基线升高至 ICU 入住时，但两组间无显著差异。两组间尿液和血浆肌酐水平及尿量无差异。根据 pRIFLE 分类（儿科评分指示风险、损伤、衰竭、功能丧失和终末期肾病的肾脏损伤水平），术后急性肾损伤（AKI）发生率在 F 组为 50%，在 P 组为 72%（P = 0.08；优势比（OR），0.38；95%置信区间（CI），0.14 至 1.02）。F 组利尿剂（呋塞米）和血管扩张剂（苯肾上腺素）的使用显著减少（P = 0.0085；OR，0.22；95%CI，0.07 至 0.7）。
结论
在伴有双心室解剖结构的 CHD 心脏手术患儿的 CPB 期间，使用高剂量芬多卡胺治疗可显著降低尿液 NGAL 和 CysC 水平，并减少 CPB 期间利尿剂和血管扩张剂的使用。
试验注册
ClinicalTrials.gov NCT00982527。
Zotero 插件