Soh Sarah, Shim Jae-Kwang, Song Jong-Wook, Bae Jae-Chan, Kwak Young-Lan
Department of Anaesthesiology and Pain Medicine, Seoul, Republic of Korea; Yonsei Cardiovascular Hospital, Seoul, Republic of Korea; Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Anaesthesiology and Pain Medicine, Seoul, Republic of Korea.
Br J Anaesth. 2020 Apr;124(4):386-394. doi: 10.1016/j.bja.2019.12.036. Epub 2020 Jan 29.
Acute kidney injury (AKI) is a frequent and serious complication after aortic surgery requiring cardiopulmonary bypass (CPB). Dexmedetomidine, a selective α-2 adrenoreceptor agonist, may reduce AKI because of its sympatholytic and anti-inflammatory effects against ischaemia-reperfusion injury. We investigated the effect of dexmedetomidine administration on AKI after aortic surgery requiring CPB in a placebo-controlled randomised controlled trial.
A total of 108 patients were randomly assigned to an infusion of dexmedetomidine or saline at a rate of 0.4 μg kg h for 24 h starting after anaesthetic induction. The primary outcome was the incidence of AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcomes included delirium and major morbidity. Safety outcomes were drug-related adverse events (bradycardia, hypotension).
AKI occurred in 7/54 (13%) subjects randomised to dexmedetomidine, compared with 17/54 (31%) subjects randomised to saline infusion (odds ratio=0.32; 95% confidence interval [CI], 0.12-0.86; P=0.026). Secondary outcomes, including stroke, mortality, and delirium, were similar between subjects randomised to dexmedetomidine (16/54 [30%] or saline control (22 [41%]; odds ratio=0.61 [95% CI, 0.28-1.36]). The incidence of bradycardia and hypotension was similar between groups (14/54 (26%) vs. 17/54 (32%) (odds ratio:0.76 (95%CI:0.33-1.76) and 29/54 (54%) vs. 36/54 (67%) (odds ratio:0.58 (95%CI:0.27-1.26), respectively). The length of hospital stay was shorter in the dexmedetomidine group (12 [10-17] days) vs saline control (15 [11-21] days; P=0.039).
Pre-emptive dexmedetomidine administration for 24 h starting after induction of anaesthesia reduced the incidence of AKI after aortic surgery requiring CPB, without any untoward side-effects related to its sedative or sympatholytic effects.
NCT02607163 (www.
gov).
急性肾损伤（AKI）是需要体外循环（CPB）的主动脉手术后常见且严重的并发症。右美托咪定是一种选择性α-2肾上腺素能受体激动剂，因其对缺血再灌注损伤的交感神经阻滞和抗炎作用，可能会降低AKI的发生率。我们在一项安慰剂对照的随机对照试验中研究了给予右美托咪定对需要CPB的主动脉手术后AKI的影响。
总共108例患者在麻醉诱导后开始以0.4μg·kg⁻¹·h⁻¹的速率随机输注右美托咪定或生理盐水，持续24小时。主要结局是根据改善全球肾脏病预后组织（KDIGO）标准定义的AKI发生率。次要结局包括谵妄和主要并发症。安全性结局是与药物相关的不良事件（心动过缓、低血压）。
随机分配至右美托咪定组的54例受试者中有7例（13%）发生AKI，而随机分配至生理盐水输注组的54例受试者中有17例（31%）发生AKI（比值比=0.32；95%置信区间[CI]，0.12 - 0.86；P = 0.026）。随机分配至右美托咪定组（16/54 [30%]）或生理盐水对照组（22/54 [41%]）的受试者之间的次要结局，包括中风、死亡率和谵妄，相似（比值比=0.61 [95% CI，0.28 - 1.36]）。两组之间心动过缓和低血压的发生率相似（分别为14/54 [26%] 对17/54 [32%]（比值比：0.76 [95% CI：0.33 - 1.76]）和29/54 [54%] 对36/54 [67%]（比值比：0.58 [95% CI：0.27 - 1.26]）。右美托咪定组的住院时间较短（12 [10 - 17]天），而生理盐水对照组为（15 [11 - 21]天；P = 0.039）。
麻醉诱导后开始预防性给予右美托咪定24小时可降低需要CPB的主动脉手术后AKI的发生率，且无任何与其镇静或交感神经阻滞作用相关的不良副作用。
NCT02607163（www.CLINICALTRIALS.gov）
