Ammar A S, Mahmoud K M, Kasemy Z A, Helwa M A
Asst. Professor in Anesthesiology Department, Minoufiya Faculty of Medicine, Minoufiya University, Minoufiya, Egypt.
Lecturer in Public Health, Statistics and Community Medicine Department, Minoufiya Faculty of Medicine, Minoufiya University, Minoufiya, Egypt.
Saudi J Anaesth. 2016 Oct-Dec;10(4):395-401. doi: 10.4103/1658-354X.177340.
Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries.
Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0.5 μg/kg/h) until 6 h after surgery, whereas the control group received an equivalent volume of physiological saline. Primary outcome measures included myocardial-specific proteins (troponin-I, creatine kinase-MB), urinary-specific kidney proteins (N-acetyl-beta-D-glucosaminidase, alpha-1-microglobulin, glutathione transferase-pi, glutathione transferase alpha), serum proinflammatory cytokines (tumor necrosis factor alpha and interleukin-1 beta), norepinephrine, and cortisol levels. They were measured within 5 min of starting anesthesia (T), at the end of surgery (T), 12 h after surgery (T), 24 h after surgery (T), 36 h postoperatively (T), and 48 h postoperatively (T). Furthermore, creatinine clearance and serum cystatin C were measured before starting surgery as a baseline, and at days 1, 4, 7 after surgery.
Dexmedetomidine reduced cardiac and renal injury as evidenced by lower concentration of myocardial-specific proteins, kidney-specific urinary proteins, and pro-inflammatory cytokines. Moreover, it caused higher creatinine clearance and lower serum cystatin C.
Dexmedetomidine provided cardiac and renal protection during cardiac surgery.
心脏和肾脏损伤是心脏手术后常见的不良情况，会导致围手术期发病和死亡。右美托咪定已被证明可保护多个器官免受缺血/再灌注（I/R）诱导的损伤。我们进行了一项随机对照试验，以评估右美托咪定对接受心脏手术患者心脏和肾脏I/R损伤的影响。
50例计划进行择期心脏手术的患者被随机分为右美托咪定组，该组在体外循环前5分钟开始持续输注右美托咪定（15分钟内输注1μg/kg，随后以0.5μg/kg/h的速度输注），直至术后6小时，而对照组接受等量的生理盐水。主要观察指标包括心肌特异性蛋白（肌钙蛋白I、肌酸激酶同工酶MB）、尿特异性肾脏蛋白（N-乙酰-β-D-氨基葡萄糖苷酶、α-1微球蛋白、谷胱甘肽转移酶-pi、谷胱甘肽转移酶α）、血清促炎细胞因子（肿瘤坏死因子α和白细胞介素-1β）、去甲肾上腺素和皮质醇水平。在麻醉开始后5分钟（T0）、手术结束时（T1）、术后12小时（T2）、术后24小时（T3）、术后36小时（T4）和术后48小时（T5）进行测量。此外，在手术开始前作为基线测量肌酐清除率和血清胱抑素C，并在术后第1天、第4天、第7天进行测量。
右美托咪定降低了心脏和肾脏损伤，表现为心肌特异性蛋白、肾脏特异性尿蛋白和促炎细胞因子的浓度较低。此外，它还导致更高的肌酐清除率和更低的血清胱抑素C。
右美托咪定在心脏手术期间提供了心脏和肾脏保护。
