右美托咪定对全麻下经皮肾镜取石术患者肾功能的影响

摘要

目的：探讨右美托咪定对肾脏结石患者全麻下经皮肾镜取石术时肾功能的影响。方法选择择期行经皮肾镜取石术患者30例,男25例,女5例,年龄40~70岁,ASA Ⅰ或Ⅱ级,按分层随机区组设计分为右美托咪定组(D 组)和对照组(C 组),每组15例。D 组在常规麻醉诱导用药前10 min 经静脉输注右美托咪定1μg/kg,随后以0.5μg·kg-1·h-1的速率静脉输注至手术结束,C组给予等容量的生理盐水。于手术开始前即刻(T0)、手术结束即刻(T1)、术后第1天(T2)和术后第3天(T3)时取静脉血样和留尿液,采用全自动生化分析仪测定血清血尿素氮(BUN)、血肌酐(Scr)、胱抑素 C(CYS-C)、视黄醇结合蛋白(RBP)的浓度,采用贝克曼特定蛋白仪测定尿α1-微球蛋白(α1-MG)、尿微量白蛋白、尿转铁蛋白(Tf)及尿液免疫球蛋白 G 的浓度。结果两组各时点 BUN 及 Scr差异无统计学意义。与 T0时比较,T1~T3时两组 CYS-C 及 RBP 明显升高(P <0.05)；T1~T3时 D组 CYS-C 及 RBP 明显低于 C 组(P <0.05)。两组各时点尿微量白蛋白、Tf 及免疫球蛋白 G 差异均无统计学意义；与 T0时比较,T1~T3时两组尿α1-MG 明显升高(P <0.05)；T1~T3时 D 组尿α1-MG 明显低于 C 组(P <0.05)。结论常规麻醉诱导前静脉输注右美托咪定1μg/kg,随后以0.5μg·kg-1·h-1的速率静脉输注至手术结束,对肾脏结石患者全麻下经皮肾镜取石术产生一定的肾脏保护作用。%Objective To investigate the effect of dexmedetomidine on renal function during percutaneous nephrolithotomy under general anesthesia in the patients with renal calculus. Methods Thirty patients (male 25 cases,female 5 cases)with renal calculi,age 40-70 yr,with body mass index of 1 9-27 kg/m2 ,ASA physical status Ⅰ or Ⅱ,scheduled for elective percutaneous neph-rolithotomy under general anesthesia,were randomized into two groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In patients of group D,dexmedetomidine 1 μg/kg were infused intravenously over 10 min before induction anesthesia,followed by infusion at a rate of 0.5 μg·kg-1 ·h-1 until the end of operation.The equal volume of normal saline was given in pa-tients of group C.Immediately before beginning of surgery (T0 ),at the end of surgery (T1 ),the first day after surgery (T2 )and the third day after surgery (T3 ),blood and urine samples were obtained. The serum and urine concentrations of urea nitrogen (BUN),serum creatinine (Scr),cystatin C (CYS-C),retinol binding protein (RBP),urinaryα1-microglobulin (α1-MG),urine micro-albumin,u-rinary transferrin,urinary immunoglobulin G was measured by automatic biochemical analyzer and Beckman specific protein analyzer.Results There was no difference in BUN and Scr at any time point between the two groups.Compared with T0 ,CYS-C and RBP at T1-T3 increased significantly in two groups (P <0.05).The levels of CYS-C and RBP in group D were lower than in group C at T1-T3 (P<0.05).There was no difference in urinary immunoglobulin G,urine micro-albumin after the start of surgery.Compared with T0 ,urinary α1-MG at T1-T3 increased significantly in two groups (P <0.05).The level of urinary α1-MG in group D was lower than in group C at T1-T3 (P < 0.05 ). Conclusion Dexmedetomidine(1 μg/kg infused intravenously before induction of anesthesia,followed by infusion at a rate of 0.5 μg·kg-1 ·h-1 until the end of operation)might provide renal protection to some extent during percutaneous nephrolithotomy under general anesthesia in the patients with renal calculi.