Zhang Rui, Wei Jianrui, Yin Haiyan, Zhu Youfeng
Central Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou 510000, Guangdong, China. Corresponding author: Wei Jianrui, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Apr;26(4):219-22. doi: 10.3760/cma.j.issn.2095-4352.2014.04.004.
To investigate the effects of trimetazidine on renal function in patients with shock.
A prospective randomized controlled double-blind study was conducted. 128 patients with shock admitted to intensive care unit (ICU) of Guangzhou Red Cross Hospital from April 2011 to April 2013 were enrolled and randomly divided into control group and trimetazidine treatment group, each n=64. All patients received anti-shock treatment, while the patients in trimetazidine group received trimetazidine treatment (20 mg orally, tid) for 7 days, and patients in control group received placebo (10 mL of sterile water for injection, tid) for 7 days. The urinary output, serum creatinine (SCr), blood urea nitrogen (BUN), cystatin C, and creatinine clearance (CCr) reflecting renal function were recorded in both groups, and the values were compared before treatment, 48 hours after treatment, and 1 week after the treatment. At the same time, dynamic mean arterial pressure (MAP) was monitored, and 48-hour and 1-week mortality rates were recorded.
There was no significant difference in results in all the renal function parameters before the treatment between two groups. The levels of SCr, BUN, cystatin C were gradually decreased after treatment in both groups, but CCr and MAP were gradually increased. Compared with the control group, cystatin C at 48 hours after treatment was significantly decreased, while CCr was significantly increased in treatment group (cystatin C: 0.85±0.81 mg/L vs. 1.01±0.91 mg/L, t=2.562, P=0.017; CCr: 0.93±0.64 mL/s vs. 0.69±0.40 mL/s, t=2.155, P=0.033). SCr and BUN at 1 week after treatment were significantly decreased in treatment group (SCr: 94.23±88.31 μmol/L vs. 104.99±98.37 μmol/L, t=2.921, P=0.003; BUN: 9.46±8.24 mmol/L vs. 11.87±8.65 mmol/L, t=2.611, P=0.010). Urine output per hour and MAP was improved after treatment in both groups, and no significant difference was found between treatment group and control group (urine output: 48 hours after treatment 55.67±31.43 mL vs. 45.34±11.79 mL, t=0.934, P=0.323; 1 week after treatment 71.67±37.23 mL vs. 75.35±22.88 mL, t=1.280, P=0.210; MAP: 48 hours after treatment 72.13±33.24 mmHg vs. 69.28±39.98 mmHg, t=1.408, P=0.179; 1 week after treatment 71.44±21.98 mmHg vs. 72.32±31.11 mmHg, t=1.184, P=0.252]. Mortality rate in treatment group was lowered compared with control group, however no statistical significance was found [48 hours after treatment: 31.2% (20/64) vs. 32.8% (21/64), χ2=0.084, P=0.785; 1 week after treatment: 32.8% (21/64) vs. 35.9% (23/64), χ2=2.084, P=0.173].
Trimetazidine can improve renal function in patients with shock.
探讨曲美他嗪对休克患者肾功能的影响。
进行一项前瞻性随机对照双盲研究。选取2011年4月至2013年4月入住广州红十字会医院重症监护病房（ICU）的128例休克患者，随机分为对照组和曲美他嗪治疗组，每组n = 64例。所有患者均接受抗休克治疗，曲美他嗪组患者接受曲美他嗪治疗（口服20 mg，每日3次），共7天，对照组患者接受安慰剂（10 mL注射用无菌水，每日3次），共7天。记录两组反映肾功能的尿量、血清肌酐（SCr）、血尿素氮（BUN）、胱抑素C及肌酐清除率（CCr），并比较治疗前、治疗后48小时及治疗后1周的值。同时监测动态平均动脉压（MAP），记录48小时及1周的死亡率。
两组治疗前所有肾功能参数结果无显著差异。两组治疗后SCr、BUN、胱抑素C水平逐渐下降，而CCr和MAP逐渐升高。与对照组相比，治疗组治疗后48小时胱抑素C显著降低，而CCr显著升高（胱抑素C：0.85±0.81 mg/L对1.01±0.91 mg/L，t = 2.562，P = 0.017；CCr：0.93±0.64 mL/s对0.69±0.40 mL/s，t = 2.155，P = 0.033）。治疗组治疗后1周SCr和BUN显著降低（SCr：94.23±88.31 μmol/L对104.99±98.37 μmol/L，t = 2.921，P = 0.003；BUN：9.46±8.24 mmol/L对11.87±8.65 mmol/L，t = 2.611，P = 0.010）。两组治疗后每小时尿量和MAP均有改善，治疗组与对照组之间无显著差异（尿量：治疗后48小时55.67±31.43 mL对45.34±11.79 mL，t = 0.934，P = 0.323；治疗后1周71.67±37.23 mL对75.35±22.88 mL，t = 1.280，P = 0.210；MAP：治疗后48小时72.13±33.24 mmHg对69.28±39.98 mmHg，t = 1.408，P = 0.179；治疗后1周71.44±21.98 mmHg对72.32±31.11 mmHg，t = 1.184，P = 0.252）。治疗组死亡率较对照组降低，但差异无统计学意义[治疗后48小时：31.2%（20/64）对32.8%（21/64），χ2 = 0.084，P = 0.785；治疗后1周：32.8%（21/64）对35.9%（23/64），χ2 = 2.084，P = 0.173]。
曲美他嗪可改善休克患者的肾功能。
