The dose-related effects of Dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study
The dose-related effects of Dexmedetomidine on renal functions and serum neutrophil gelatinase-associated lipocalin values after coronary artery bypass grafting: a randomized, triple-blind, placebo-controlled study
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DOI：
10.1093/icvts/ivu367
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发表时间：
2015-02-01
影响因子：
--
通讯作者：
Ipek, Gokhan
中科院分区：
文献类型：
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作者：
Balkanay, Ozan Onur;Goksedef, Deniz;Ipek, Gokhan
冠状动脉旁路移植术（CABG）后急性肾功能衰竭是一种严重的并发症，可增加发病率和死亡率。早期发现和预防这种并发症非常重要。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是一种新的生物标志物，在急性肾损伤的早期诊断中具有重要作用。最近发表了关于右美托咪定对心脏手术有利影响的研究。本研究的目的是调查右美托咪定是否对中性粒细胞明胶酶相关脂质运载蛋白水平和肾功能有剂量依赖性的积极作用，当使用后CABG.METHODS：我们的随机，三盲，安慰剂对照研究中进行了295例患者之间的CABG手术安排在2009年8月和2011年3月在三级心脏和血管外科诊所。共有90名符合入选标准的连续患者被随机分为三组。第一组接受安慰剂。第二组和第三组分别接受4和8 μ g/cc浓度的右美托咪定输注。调节输注速率以获得Ramsey镇静评分为2或3的镇静。根据右美托咪定总剂量对患者重新分组。破盲前对所有六种可能性进行了血清中性粒细胞明胶酶相关脂质运载蛋白值和常规肾功能检查等变量的统计分析。结果：常规肾功能检查结果无显著差异。然而，安慰剂、低剂量和高剂量右美托咪定组术后第一天的中性粒细胞明胶酶相关脂质运载蛋白水平分别为176.8 +/- 145.9、97.7 +/- 63.4和67.3 +/- 10.9 ng/ml。结论：在我们的研究中，我们发现右美托咪定输注用于体外循环下CABG术后镇静可用于预防肾损伤。常规的肾功能检查，包括血尿素氮、血清肌酐、尿量和肌酐清除率测量，通常可能无法检测到术后前48小时内急性肾功能不全的发生。在术后早期检测到肾功能的差异，并且通过测量血液NGAL水平确定急性肾损伤的发展是显著的且具有剂量依赖性。
OBJECTIVES: Acute kidney failure after coronary artery bypass grafting (CABG) is a serious complication that increases morbidity and mortality rates. Early detection and prevention of this complication are very important. A novel biomarker named neutrophil gelatinaseassociated lipocalin (NGAL) can play an important role in early diagnosis of acute kidney injury. Recent studies on the favourable effects of Dexmedetomidine on cardiac surgery have been published. The aim of this study is to investigate whether there is a dose-dependent positive effect of Dexmedetomidine on neutrophil gelatinase-associated lipocalin levels and renal functions when used after CABG.METHODS: Our randomized, triple-blinded, placebo-controlled study was conducted among 295 patients scheduled for CABG surgery between August 2009 and March 2011 in a tertiary cardiac and vascular surgery clinic. A total of 90 consecutive patients who met inclusion criteria were randomized and divided into three groups. The first group received a placebo. The second and the third groups received 4 and 8 mu g/cc concentration of the Dexmedetomidine infusion, respectively. Infusion rates were regulated to obtain sedation with a Ramsey sedation score of 2 or 3. Patients were regrouped according to the total Dexmedetomidine dose. Statistical analyses of variables including serum neutrophil gelatinase-associated lipocalin values and conventional renal function tests were made for all six possibilities before the blind was broken.RESULTS: Results of conventional renal function tests were not significantly different. However, neutrophil gelatinase-associated lipocalin levels for the first postoperative day for placebo, low-dose and high-dose Dexmedetomidine groups were 176.8 +/- 145.9, 97.7 +/- 63.4 and 67.3 +/- 10.9 ng/ml, respectively. These values were significantly different among the groups (P < 0.001).CONCLUSIONS: In our study, we found that Dexmedetomidine infusion for sedation after CABG under cardiopulmonary bypass can be useful in the prevention of kidney injury. Conventional renal function tests, including blood urea nitrogen, serum creatinine, urine output and creatinine clearance rate measurements typically may not detect the development of acute kidney dysfunction in the first 48-h postoperative period. Differences were detected in renal function in the early postoperative period and the development of acute kidney injury, as determined by measurements of blood NGAL levels, was significant and dose-dependent.