脓毒症急性肾损伤患者使用右美托咪啶镇静对肾功能的保护作用

Protective Effect of Dexmedetomidine Sedation on Renal Function in Patients with Septic Acute Kidney Injury

摘要: 目的：探讨使用右美托咪啶对脓毒症急性肾损伤(AKI)病人镇静过程中对病人肾功能产生的作用。方法：选择脓毒症AKI的病患54例，随机分组成观察组(A组)与对照组(B组)，各27例，入组后实施镇静策略，包含镇痛、镇静、评估、每日中断镇静4个部分，在实施前(T₀)、实施后第一日(T₁)、第二日(T₂)、第三日(T₃)、第六日(T₄)早上取静脉血，测量血肌酐(Scr)、胱抑素C (CysC)含量，取尿液测量中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)含量，同时记录镇静实施后4个时间点的肾脏顺序器官衰竭评估(SOFA)亚评分。结果：在组内比较中，和T0相比，A组在T₂时，Scr水平显示明显降低(P < 0.05)。在组间比较中，和B组相比，A组在T₁、T₂、T₃时Scr水平显著下降(P < 0.05)，在T₂、T₃、T₄时uNGAL明显降低，在T₂、T₃时血清CysC显著降低，在T4时肾脏SOFA亚评分降低(P < 0.05)。结论：使用右美托咪定镇静时可以降低脓毒症AKI病患Scr、CysC、uNGAL水平及肾的SOFA亚评分，可能具有保护和改善肾功能作用。

Abstract: Objective: To investigate the effect of dexmedetomidine sedation strategy on renal function in pa-tients with kidney injury caused by sepsis. Methods: 54 patients with acute renal injury of sepsis were selected. They were randomly divided into dexmedetomidine group (experimental group, group D), Non-dexmedetomidine group (control group, group C), 27 cases in each group. The two groups were given a sedation strategy, including analgesia, sedation, evaluation, daily interruption of sedation. The blood samples and urine sample of the patients were taken immediately before sedation (T₀), the first day after sedation (T₁), the second day after sedation (T₂), the third day after sedation (T₃), the sixth day after sedation (T₄), to determine the level of Scr, CysC, and urine the lev-el of NGAL, compare the changes in the renal sequential organ failure assessment (SOFA) subscores from the baseline within five points in times after randomization between groups. Result: Within the data of intra-group, compared with T0 time point, the levels of serum Scr in group D significantly decreased at T₂ time point (P < 0.05). But group C had no significant difference at all time points (P > 0.05). Within the data of inter-group, compared with group C, the level of serum Scr in group D significantly decreased at T₁, T₂ and T₃ time point (P < 0.05), the level of unire neutrophil gelatinase associated lipocalin (NGAL) in group D significantly decreased at T₂ , T₃ and T4 time point (P < 0.05), the level of cystatin C in group D significantly decreased at T₂ and T3 time point (P < 0.05). While the renal SOFA subscore at the baseline was similar for both groups, it significantly decreased in the D group at T4 time point (P < 0.05). Conclusion: A sedation strategy with dexmedetomidine can effec-tively decrease the levels of serum Scr and CysC and unire NGAL for AKI patients. A sedation strate-gy with dexmedetomidine is associated with improving renal function among patients with sepsis.