右美托咪定对失血性休克患者肾功能的影响

发布时间：2018-03-09 15:36

本文选题：失血性休克　切入点：右美托咪定　出处：《临床麻醉学杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨术中使用右美托咪定对失血性休克患者肾功能的影响。方法选择本院拟行急诊全麻下手术治疗的失血性休克患者60例,男27例,女33例,年龄18~69岁,ASAⅢ或Ⅳ级。将患者随机分为两组:右美托咪定组(D组)和对照组(C组),每组30例。两组患者均在手术止血的同时积极进行容量复苏治疗,D组在麻醉诱导后切皮前给予右美托咪定0.5μg/kg,给药时间10min,随后以0.4μg·kg~(-1)·h~(-1)的速率静脉输注至术毕前30min,C组给予等容量的生理盐水。分别于切皮前即刻(T_1)、术毕即刻(T_2)、术毕24h(T_3)、术毕72h(T_4)时采集静脉血样,检测血清肌酐(Scr)和尿素氮(BUN)浓度、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和高迁移率族蛋白1(HMGB1)含量,计算并比较T_4时血清Scr浓度和T_3时HMGB1含量较T_1时的变化幅度(ΔScr和ΔHMGB1),并记录患者T_1、T_2时MAP、HR等血流动力学指标和剩余碱(BE)、乳酸(Lac)等动脉血气结果。结果与T_1时比较,T_2时两组MAP、CVP和BE明显升高,HR和Lac明显降低(P0.05),组间比较无统计学差异。与T_1时比较,T_3、T_4时D组血清Scr浓度明显降低(P0.05);D组ΔScr明显小于C组(P0.05)。两组患者各时点血清BUN浓度差异无统计学意义。与T_1时比较,T_4时D组血清NGAL含量明显减少(P0.01);T_4时D组血清NGAL含量明显少于C组(P0.05)。与T_1时比较,T_2时两组患者血清HMGB1含量明显减少(P0.05);T_3时C组血清HMGB1含量明显增加(P0.01);T_3时C组血清HMGB1含量明显多于D组(P0.05);C组ΔHMGB1明显大于D组(P0.05)。结论右美托咪定可抑制缺血-再灌注后血清促炎因子HMGB1含量的增加,有利于失血性休克患者肾功能的恢复。
[Abstract]:Objective to investigate the effect of dexmetomidine on renal function in patients with hemorrhagic shock. Methods Sixty patients with hemorrhagic shock, 27 males and 33 females, were selected for operation under emergency general anesthesia in our hospital. The patients were randomly divided into two groups: dexmetomidine group D (n = 30) and control group C (n = 30). All patients in both groups were treated with volume resuscitation while the operation was hemostasis and volume resuscitation therapy was performed in group D during anesthesia induction. Right metoimidine was given 0.5 渭 g / kg before skin incision for 10 mins, and then intravenous infusion of 0.4 渭 g 路kg -1) 路hm-1) was given to group C 30 minutes before the end of operation. Blood samples were collected immediately before skin incision, immediately before operation, immediately after operation, 24 h after operation, 72 h after operation, and 72 h after operation, respectively. Serum creatinine (SCR) and urea nitrogen (bun) concentrations, neutrophil gelatinase-associated lipid transport protein (NGALs) and high mobility group protein (HMGB1) were measured. To calculate and compare the changes of serum Scr concentration in T _ 4 and HMGB1 in T _ 3 compared with T _ 1 (螖 Scr and 螖 HMGB1), and to record the hemodynamic indexes of T _ (1) and T _ (2) and the results of arterial blood gas such as residual alkaloid, lactic acid and so on. The results were compared with those of T _ (1) and T _ (2). The levels of Scr in group D were significantly lower than those in group C at T3 and T4. The level of 螖 Scr in group D was significantly lower than that in group C (P 0.05). There was no significant difference between the two groups in serum BUN concentration at different time points. There was no statistical significance. The serum NGAL content in group D was significantly lower than that in group C at P0.01 / T _ 4 compared with that in group T _ 1. The content of serum NGAL in group D was significantly lower than that in group C (P 0.05). Compared with T _ T _ 1, the content of serum HMGB1 in group C was significantly lower than that in group C at T _ (0.05) / T _ (3). The level of serum HMGB1 in group C was significantly higher than that in group D (P 0.05). Conclusion dexmetomidine can inhibit the increase of serum pro-inflammatory factor HMGB1 after ischemia-reperfusion. It is beneficial to the recovery of renal function in patients with hemorrhagic shock.
【作者单位】：南昌大学第一附属医院麻醉科;
【基金】：江西省卫计委科技计划项目(20131048)
【分类号】：R614

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