Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, Hangzhou 310014, China; Department of Intensive Care Unit, People's Hospital of Hangzhou Medicine College, Hangzhou 310014, China; Department of Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou 310014, China.
Department of Respiratory Medicine, The Affiliated Hospital of Hangzhou Normal University (The 2nd People's Hospital of Hangzhou), Hangzhou 310014, China.
Ann Palliat Med. 2020 Mar;9(2):224-230. doi: 10.21037/apm.2020.02.08. Epub 2020 Mar 2.
This study aimed to assess the relationship between the use of dexmedetomidine and the incidence of acute kidney injury (AKI) in septic shock patients undergoing mechanical ventilation and reveal the potential mechanism.
Septic shock patients undergoing mechanical ventilation were included. Patients were randomized into two groups including propofol group and dexmedetomidine group. Plasma samples were obtained from veins at 0, 12, 24, 72 and 120 h after receiving mechanical ventilation in ICU.
Cohorts with septic shock after mechanical ventilation in ICU had similar baseline and demographic characteristics. Serum creatinine (SCr) and blood urea nitrogen (BUN) was lower in dexmedetomidine group (P<0.05) and also lower renal injury markers were detected in the dexmedetomidine group, compared with propofol group (P<0.05). Dexmedetomidine infusion reduced the TNF-α, IL-1 level in blood samples and maintained the balance of proportion of CD4+ and CD8+ T-lymphocytes. Patients receiving dexmedetomidine were less likely to develop AKI. The median ICU stay was decreased in dexmedetomidine group (P<0.05). Moreover, the case and duration of CRRT was also decreased by using dexmedetomidine (P<0.05). There was no significant difference between the cohorts with respect to the duration of mechanical ventilation.
The use of dexmedetomidine infusion in ICU patients was associated with a decreased incidence of AKI and reduced ICU stay and CRRT performance. The mechanism may be related to antiinflammatory reaction and immunoregulation.
本研究旨在评估机械通气的脓毒症休克患者中使用右美托咪定与急性肾损伤（AKI）发生率之间的关系，并揭示其潜在机制。
纳入接受机械通气的脓毒症休克患者。患者随机分为两组，包括丙泊酚组和右美托咪定组。在 ICU 接受机械通气后 0、12、24、72 和 120 h 从静脉采集血浆样本。
ICU 机械通气后的脓毒症休克队列具有相似的基线和人口统计学特征。右美托咪定组血清肌酐（SCr）和血尿素氮（BUN）较低（P<0.05），并且右美托咪定组的肾损伤标志物也较低，与丙泊酚组相比（P<0.05）。右美托咪定输注降低了血液样本中的 TNF-α、IL-1 水平，并维持了 CD4+和 CD8+T 淋巴细胞比例的平衡。接受右美托咪定治疗的患者发生 AKI 的可能性较低。右美托咪定组 ICU 停留时间中位数降低（P<0.05）。此外，使用右美托咪定也降低了 CRRT 的例数和持续时间（P<0.05）。两组机械通气持续时间无显著差异。
ICU 患者使用右美托咪定输注与 AKI 发生率降低、ICU 停留时间和 CRRT 性能降低相关。其机制可能与抗炎反应和免疫调节有关。
