Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study.
Renal effects of dexmedetomidine during coronary artery bypass surgery: a randomized placebo-controlled study.
复制标题
DOI：
10.1186/1471-2253-11-9
复制
发表时间：
2011-05-23
影响因子：
2.2
通讯作者：
Dexmedetomidine in Cardiac Surgery Study Group
中科院分区：
文献类型：
--
作者：
Leino K;Hynynen M;Jalonen J;Salmenperä M;Scheinin H;Aantaa R;Dexmedetomidine in Cardiac Surgery Study Group
右美托咪定是一种α2-肾上腺素能受体激动剂，已被评估为麻醉的辅助药物，用于镇静和围手术期血流动力学稳定。它引起剂量依赖和中枢介导的交感神经溶解。体外循环冠状动脉旁路移植术(CABG)是一种应激性手术，由于交感神经系统、血流动力学和肾功能的相互关系，增加交感神经系统的活动，从而导致肾功能的减弱。在术后头两天，我们验证了右旋美托咪定可以改善接受择期冠状动脉搭桥术患者的肾功能的假设。这是一项双盲、随机、平行分组研究。选择肾功能正常、择期行冠状动脉旁路移植术的患者，随机分为安慰剂组和右美托咪啶组，分别于麻醉诱导后开始静脉滴注右美托咪定，直至术后4h。主要终点是内生肌酐清除量。其他变量包括尿肌酐和排出量、钠和钾排泄分数、尿钾、钠和葡萄糖、血和尿渗透压以及血浆儿茶酚胺浓度。数据分析采用重复测量方差分析或Cochran-Mantel-Haenszel检验。随机分组的87名患者中有66名可评估用于分析。除了在插入导尿管后的前4小时内，右美托咪定组的尿量平均增加了74%(p<；0.001)，其余的肾功能指标在组间均无显著差异。可信区间检验显示，样本量足够大，可用于肌酐清除量的无差异声明。在这组风险相对较低的择期冠状动脉搭桥术患者中，静脉注射右美托咪定并未改变肾功能，但与尿量增加有关。这项研究是在1994-1997年进行的，因此没有登记。
Dexmedetomidine, an alpha2-adrenoceptor agonist, has been evaluated as an adjunct to anesthesia and for the delivery of sedation and perioperative hemodynamic stability. It provokes dose-dependent and centrally-mediated sympatholysis. Coronary artery bypass grafting (CABG) with extracorporeal circulation is a stressful procedure increasing sympathetic nervous system activity which could attenuate renal function due the interrelation of sympathetic nervous system, hemodynamics and renal function. We tested the hypothesis that dexmetomidine would improve kidney function in patients undergoing elective CABG during the first two postoperative days. This was a double-blind, randomized, parallel-group study. Patients with normal renal function and scheduled for elective CABG were randomized to placebo or to infusion of dexmedetomidine to achieve a pseudo steady-state plasma concentration of 0.60 ng/ml. The infusion was started after anesthesia induction and continued until 4 h after surgery. The primary endpoint was creatinine clearance. Other variables included urinary creatinine and output, fractional sodium and potassium excretion, urinary potassium, sodium and glucose, serum and urinary osmolality and plasma catecholamine concentrations. The data were analyzed with repeated-measures ANOVA or Cochran-Mantel-Haenszel test. Sixty-six of 87 randomized patients were evaluable for analysis. No significant between-group differences were recorded for any indices of renal function except for a mean 74% increase in urinary output with dexmedetomidine in the first 4 h after insertion of a urinary catheter (p < 0.001). Confidence interval examination revealed that the sample size was large enough for the no-difference statement for creatinine clearance. Use of intravenous dexmedetomidine did not alter renal function in this cohort of relatively low-risk elective CABG patients but was associated with an increase in urinary output. This study was carried out in 1994-1997 and was thus not registered.
登录
查看更多内容
影响因子：
9.8
作者：
Sear, JW
通讯作者：
Sear, JW
影响因子：
10.7
作者：
Lawrence, CJ;DeLange, S
通讯作者：
DeLange, S
DOI：
10.1016/s1053-0770(03)00200-3
发表时间：
2003-10-01
影响因子：
2.8
作者：
Herr, DL;Sum-Ping, STJ;England, M
通讯作者：
England, M
影响因子：
6.7
作者：
Frumento, Robert J.;Logginidou, HeLene G.;Sladen, Robert N.
通讯作者：
Sladen, Robert N.
影响因子：
5.7
作者：
Talke, P;Richardson, CA;Fisher, DM
通讯作者：
Fisher, DM