张雅静 芦树军 齐庆岭

摘 要：目的 探讨体外循环过程中，预充右美托咪定对心脏手术患者肾功能的影响。方法 2014年1月～2017年1月于天津市第一中心医院择期行CPB心脏直视手术患者86例，随机分为对照组（C组）与观察组（D组），各43例。D组预充液加右美托咪定注射液1 μg/kg，C组预充液加等量生理盐水。在转机前（T0），转机后10 min（T1），升主动脉阻断后10 min（T2），升主动脉开放后10 min（T3），CPB结束后（T4）抽取血样检测NGAL、Cys-C和β2-MG；在各时间点经食道超声监测两组患者肾动脉内径、肾动脉平均血流速度和肾血流量。结果 ①与T0比较，T3、T4时两组患者NGAL均升高，差异有统计学意义（P<0.05）；T4时C组NGAL水平高于D组，差异有统计学意义（P<0.05）；②与T0比较，T3、T4时两组患者Cys-C均升高，差异有统计学意义（P<0.05）；但两组间Cys-C水平各时间点比较，差异无统计学意义（P>0.05）；③与T0比较，T2、T3和T4两组β2-MG均升高，差异有统计学意义（P<0.05）；且T2、T3和T4时，D组患者β2-MG水平均低于C组，差异有统计学意义（P<0.05）；④D组患者动脉平均血流速度在T3、T4时均高于T0时，差异有统计学意义（P<0.05），肾血流量在T2、T3和T4时均高于T0时，差异有统计学意义（P<0.05）；T3、T4时刻，D组患者肾动脉平均血流速度均高于C组，差異有统计学意义（P<0.05）； T2、T3和T4时刻，D组患者肾血流量均高于C组，差异有统计学意义（P<0.05）。结论 右美托咪定对CPB下心脏手术围术期肾功能具有保护作用，可有效抑制肾脏损伤，维持肾血流动力学稳定，提高围术期安全性。

关键词：右美托咪定；体外循环；预充液；肾功能

中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.20.039

文章编号：1006-1959（2018）20-0131-03

Abstract：Objective To investigate the effect of pre-filled dexmedetomidine on renal function in patients undergoing cardiac surgery during cardiopulmonary bypass.Methods From January 2014 to January 2017，86 patients with CPB open heart surgery were selected in Tianjin First Central Hospital.They were randomly divided into control group（group C）and observation group（group D），43 cases each.Group D prefilled plus dexmedetomidine injection 1 μg/kg，group C prefilled with the same amount of normal saline.Before the transfer（T0），10 min after the transfer（T1），10 min after the ascending aorta（T2），10 min after the ascending aorta（T3），and after the end of the CPB（T4），the blood samples were taken to detect NGAL，Cys-C and β2-MG；renal artery diameter，renal artery mean blood flow velocity and renal blood flow were monitored by esophageal ultrasound at each time point.Results ①Compared with T0，NGAL was increased in both groups at T3 and T4，the difference was statistically significant（P<0.05）.The level of NGAL in group C was higher than that in group D at T4，the difference was statistically significant（P<0.05）.②Compared with T0，Cys-C was increased in both groups at T3 and T4，the difference was statistically significant（P<0.05）.However，there was no significant difference in Cys-C levels between the two groups（P>0.05）.③Compared with T0，β2-MG increased in T2，T3 and T4 groups，the difference was statistically significant（P<0.05）；and in T2，T3 and T4，the β2-MG level in group D was lower than that in group C，the difference was statistically significant（P<0.05）；④The mean blood flow velocity of patients in group D was higher than T0 at T3 and T4，the difference was statistically significant（P<0.05），and the renal blood flow was higher than T0 at T2，T3 and T4，the difference was statistically significant（P<0.05）；at T3 and T4，the mean blood flow velocity of renal artery in group D was higher than that in group C，the difference was statistically significant（P<0.05）.At T2，T3 and T4，the renal blood flow of group D was higher than that of group C，the difference was statistically significant（P<0.05）.Conclusion Dexmedetomidine has a protective effect on perioperative renal function in patients undergoing cardiac surgery under CPB，which can effectively inhibit kidney damage，maintain renal hemodynamic stability，and improve perioperative safety.

Key words：Dexmedetomidine；Cardiopulmonary bypass；Prefilled；Renal function

體外循环（cardiopulmonary bypass，CPB）下心内直视手术时需要使用大量升压药及血浆制品，心肌缺血容易造成肾血流灌注不足，导致肾功能损害引起严重并发症。右美托咪定是高度选择性的α2-肾上腺素能受体激动剂，具有抗交感神经兴奋、镇静及镇痛，许多研究已表明右美具有保护器官功能，包括围术期肾功能保护。CPB预充液中加入右美托咪定是否可以影响肾血流动力学，对肾功能起到保护作用，目前尚未见到相关报道。本研究主要探讨在体外循环过程，预充右美托咪定是否影响肾血流动力学，增加肾灌注，保护肾功能。

1 资料与方法

1.1一般资料 选择天津中医药大学第一附属医院2014年1月～2017年1月行CPB心脏直视手术患者86例。本研究已获得本院医学伦理委员会批准。……