Li Bo, Chen Minghua, Zeng Youjie, Luo Siwan
Operation Center, Third Xiangya Hospital, Central South University, Changsha, China.
Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha, China.
Front Pharmacol. 2023 Mar 29;14:1143176. doi: 10.3389/fphar.2023.1143176. eCollection 2023.
Previous studies have suggested that dexmedetomidine may have a protective effect on renal function. However, it is currently unclear whether perioperative dexmedetomidine administration is associated with postoperative acute kidney injury (AKI) incidence risk in hypertensive patients undergoing non-cardiac surgery. This investigation was a retrospective cohort study. Hypertensive patients undergoing non-cardiac surgery in Third Xiangya Hospital of Central South University from June 2018 to December 2019 were included. The relevant data were extracted through electronic cases. The univariable analysis identified demographic, preoperative laboratory, and intraoperative factors associated with acute kidney injury. Multivariable stepwise logistic regression was used to assess the association between perioperative dexmedetomidine administration and postoperative acute kidney injury after adjusting for interference factors. In addition, we further performed sensitivity analyses in four subgroups to further validate the robustness of the results. A total of 5769 patients were included in this study, with a 7.66% incidence of postoperative acute kidney injury. The incidence of postoperative acute kidney injury was lower in the dexmedetomidine-administered group than in the control group (4.12% vs. 8.06%, < 0.001). In the multivariable stepwise logistic regression analysis, perioperative dexmedetomidine administration significantly reduced the risk of postoperative acute kidney injury after adjusting for interference factors [odds ratio (OR) = 0.56, 95% confidence interval (CI): 0.36-0.87, = 0.010]. In addition, sensitivity analysis in four subgroups indicated parallel findings: i) eGRF <90 mL/min·1.73/m subgroup (OR = 0.40, 95% CI: 0.19-0.84, = 0.016), ii) intraoperative blood loss <1000 mL subgroup (OR = 0.58, 95% CI: 0.36-0.94, = 0.025), iii) non-diabetes subgroup (OR = 0.51, 95% CI: 0.29-0.89, = 0.018), and iv) older subgroup (OR = 0.55, 95% CI: 0.32-0.93, = 0.027). In conclusion, our study suggests that perioperative dexmedetomidine administration is associated with lower risk and less severity of postoperative acute kidney injury in hypertensive individuals undergoing non-cardiac surgery. Therefore, future large-scale RCT studies are necessary to validate this benefit.
既往研究表明，右美托咪定可能对肾功能具有保护作用。然而，目前尚不清楚围手术期给予右美托咪定是否与接受非心脏手术的高血压患者术后急性肾损伤（AKI）的发病风险相关。本研究为一项回顾性队列研究。纳入了2018年6月至2019年12月在中南大学湘雅三医院接受非心脏手术的高血压患者。通过电子病历提取相关数据。单因素分析确定了与急性肾损伤相关的人口统计学、术前实验室检查及术中因素。采用多因素逐步逻辑回归分析，在调整干扰因素后评估围手术期给予右美托咪定与术后急性肾损伤之间的关联。此外，我们在四个亚组中进一步进行了敏感性分析，以进一步验证结果的稳健性。本研究共纳入5769例患者，术后急性肾损伤的发生率为7.66%。右美托咪定给药组术后急性肾损伤的发生率低于对照组（4.12% 对8.06%，<0.001）。在多因素逐步逻辑回归分析中，围手术期给予右美托咪定在调整干扰因素后显著降低了术后急性肾损伤的风险[比值比（OR）=0.56，95%置信区间（CI）：0.36 - 0.87，P = 0.010]。此外，四个亚组的敏感性分析显示了相似的结果：i）估算肾小球滤过率（eGRF）<90 mL/min·1.73/m²亚组（OR = 0.40，95% CI：0.19 - 0.84，P = 0.016），ii）术中失血量<1000 mL亚组（OR = 0.58，95% CI：0.36 - 0.94，P = 0.025），iii）非糖尿病亚组（OR = 0.51，95% CI：0.29 - 0.89，P = 0.018），以及iv）老年亚组（OR = 0.55，95% CI：0.32 - 0.93，P = 0.027）。总之，我们的研究表明，围手术期给予右美托咪定与接受非心脏手术的高血压患者术后急性肾损伤的较低风险及较轻严重程度相关。因此，未来有必要开展大规模随机对照试验（RCT）研究来验证这一益处。
