Jo Youn Yi, Kim Ji Young, Lee Ji Yeon, Choi Chang Hu, Chang Young Jin, Kwak Hyun Jeong
Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul Department of Cardiovascular Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Medicine (Baltimore). 2017 Jul;96(28):e7480. doi: 10.1097/MD.0000000000007480.
Dexmedetomidine has been reported to have a renal protective effect after adult open heart surgery. The authors hypothesized that intraoperative infusion of dexmedetomidine would attenuate the decrease in renal function after pediatric open heart surgery.
Twenty-nine pediatric patients (1-6 years) scheduled for atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n = 14) or dexmedetomidine (a bolus dose of 0.5 μg/kg and then an infusion of 0.5 μg/kg/h) (dexmedetomidine group, n = 15) from anesthesia induction to the end of cardiopulmonary bypass. Serum creatinine (Scr) was measured before surgery (T0), 10 minutes after anesthesia induction (T1), 5 minutes after cardiopulmonary bypass weaning (T2), 2 hours after T2 (T3), and after postoperative day 1 (POD1) and postoperative day 2 (POD2) and estimated glomerular filtration rates (eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3. Acute kidney injury (AKI) was defined as an absolute increase in Scr of ≥ 0.3 mg/dL or a percent increase in Scr of ≥50%.
The incidence of AKI during the perioperative period was significantly higher in the control group than in the dexmedetomidine group (64% [9/14] vs 27% [4/15], P = .042). eGFR was significantly lower in the control group than in the dexmedetomidine group at T2 (72.6 ± 15.1 vs 83.9 ± 13.5, P = .044) and T3 (73.4 ± 15.4 vs 86.7 ± 15.9, P = .03).
Intraoperative infusion of dexmedetomidine may reduce the incidence of AKI and suppress post-bypass eGFR decline.
据报道，右美托咪定对成人心脏直视手术后具有肾脏保护作用。作者推测，小儿心脏直视手术后，术中输注右美托咪定可减轻肾功能下降。
29例计划行房间隔或室间隔缺损修补术的小儿患者（1 - 6岁）被随机分配，从麻醉诱导至体外循环结束，分别接受持续输注生理盐水（对照组，n = 14）或右美托咪定（负荷剂量0.5μg/kg，然后以0.5μg/kg/h输注）（右美托咪定组，n = 15）。于手术前（T0）、麻醉诱导后10分钟（T1）、体外循环停机后5分钟（T2）、T2后2小时（T3）、术后第1天（POD1）和术后第2天（POD2）测量血清肌酐（Scr），并计算估计肾小球滤过率（eGFR）。于T1、T2和T3测量肾脏生物标志物。急性肾损伤（AKI）定义为Scr绝对值增加≥0.3mg/dL或Scr百分比增加≥50%。
围手术期AKI的发生率在对照组显著高于右美托咪定组（64% [9/14] 对27% [4/15]，P = 0.042）。在T2时，对照组的eGFR显著低于右美托咪定组（72.6 ± 15.1对83.9 ± 13.5，P = 0.044），在T3时也是如此（73.4 ± 15.4对86.7 ± 15.9，P = 0.03）。
术中输注右美托咪定可能降低AKI的发生率，并抑制体外循环后eGFR的下降。
