Dexmedetomidine infusion is associated with enhanced renal function after thoracic surgery (Retracted article. See vol. 18, pg. 422, 2006)
Dexmedetomidine infusion is associated with enhanced renal function after thoracic surgery (Retracted article. See vol. 18, pg. 422, 2006)
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DOI：
10.1016/j.jclinane.2006.02.005
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发表时间：
2006-09-01
影响因子：
6.7
通讯作者：
Sladen, Robert N.
中科院分区：
文献类型：
--
作者：
Frumento, Robert J.;Logginidou, HeLene G.;Sladen, Robert N.
研究目的：为了验证选择性α-2激动剂右美托咪定能提高尿流率和围手术期肾功能的假说，对最近完成的一项用于开胸术后硬膜外镇痛的右美托咪定辅助研究进行了后组分析。设计：一项随机、安慰剂对照、双盲临床试验的后组分析。地点：三级护理大学医学中心。患者：28名接受择期开胸手术的患者。干预：患者被前瞻性随机分为两组，分别接受24小时静脉滴注右旋美托咪定(0.4 mU kg(-1)h(-1)，n=14)或生理盐水安慰剂(等量输注率，n=14)。测量：记录肾脏可用参数，包括尿量、计算的内生肌酐清除量(Ccl(Cr))、每日血肌酐(S-Cr)和S-铬水平的变化分数(增量S-Cr%，[术后峰值SC，基线S-CrX100]/基线S-CrX100)。两组之间的基线值没有显著差异。右美托咪胺组术后4h累积尿量(473±/-35vs290+/-122mL，P=0.001)和12h累积尿量(1033+/-240mLvs822+/-234mL，P=0.02)明显高于对照组(43%)。与对照组相比，右美托咪胺组患者围手术期肾功能的恢复明显好于对照组(P=0.0007)。肾功能恢复前肾功能正常但限制液体的开胸术后患者，在硬膜外输注右美托咪定的基础上加用右美托咪定可明显改善患者的利尿反应。尽管这一发现可能是肾小管抗利尿的简单逆转，但与对照组相比，较低的Delta S-Cr%和CCl(Cr)的保存对肾小球滤过有有利的影响。(C)2006 Elsevier Inc.保留所有权利。
Study Objective: To test the hypothesis that dexmedetomidine, a selective alpha-2 agonist, enhances urine flow rate and perioperative renal function, a post hoc analysis was conducted on a recently completed study of dexmedetomidine used as an adjunct to epidural analgesia after thoracotomy.Design: Post hoc analysis of a randomized, placebo-controlled, double-blind clinical trial.Setting: Tertiary-care university medical center.Patients: 28 patients undergoing elective thoracotomy.Interventions: Patients were prospectively randomized to receive a supplemental 24-hour intravenous infusion of either dexmedetomidine (0.4 mu g kg(-1) h(-1), n = 14) or saline placebo (equivalent infusion rate, n = 14).Measurements: Available renal parameters including urine output, calculated creatinine clearance (cCl(Cr)), daily serum creatinine level (S-Cr), and the fractional change in S-Cr level (Delta S-Cr%, [peak postoperative Sc, - baseline S-Cr] / baseline S-Cr) X 100) were recorded.Main Results: Values are expressed as means +/- SD. There were no significant differences in baseline values between the groups. The dexmedetomidine group had significantly greater cumulative urine output at postoperative hour 4 (473 +/- 35 vs 290 +/- 122 mL, P = 0.001) and 12 (1033 +/- 240 vs 822 +/- 234 mL, P = 0.02), although only 14% of the group received diuretic agents, compared with 43% in the control group. The dexmedetomidine group had significantly better preserved perioperative renal function compared with the control group, as assessed by Delta S-Cr% (0.04% decrease vs 21% increase, P = 0.0007) and cCl(Cr) (75.3 +/- 13.2 vs 62.5 +/- 15.5 mL/min, P = 0.02).Conclusion: Dexmedetomidine infusion administered as a supplement to epidural analgesia induced diuresis in postthoracotomy patients with normal preoperative renal function and undergoing fluid restriction. Although this finding may represent simple reversal of a tubular antidiuresis, the lower Delta S-Cr% and preservation of cCl(Cr) suggest a beneficial effect on glomerular filtration compared with controls. (c) 2006 Elsevier Inc. All rights reserved.