CAJ | 학술논문

目的：探讨右美托咪定对CPB心脏瓣膜置换术患者肾血流动力学的影响。方法择期拟行CPB心脏瓣膜置换术患者30例，年龄18～60岁，体重42～68 kg，ASA分级Ⅱ?Ⅳ级。采用随机数字表法分为2组（ n＝15）：对照组（ C组）和右美托咪定组（ D组）。 D组麻醉诱导后经10 min静脉输注右美托咪定负荷量0．5μg∕kg，随后以0．5～1．0μg·kg－1·h－1的速率静脉输注至手术结束。于麻醉诱导后即刻（右美托咪定给药前）、CPB 30 min、CPB结束后30 min时采用经食管超声心动图测量CO和肾血流动力学指标：肾动脉内径、肾动脉平均血流速度、肾血流量、肾动脉搏动指数和阻力指数。于麻醉诱导后即刻、CPB结束后2、12和24 h时取桡动脉血样，采用ELISA法测定血浆中性粒细胞白明胶酶相关脂质运载蛋白和胱抑素C的浓度。结果与C组比较，D组CPB 30 min和CPB结束后30 min时肾血流量增加，CPB结束后各时点血浆中性粒细胞白明胶酶相关脂质运载蛋白浓度降低（ P＜0．05），其余肾血流动力学指标、CO和血浆胱抑素C浓度差异无统计学意义（ P＞0．05）。结论右美托咪定可增加CPB心脏瓣膜置换术患者肾血流量，产生肾保护作用。
목적：탐토우미탁미정대CPB심장판막치환술환자신혈류동역학적영향。방법택기의행CPB심장판막치환술환자30례，년령18～60세，체중42～68 kg，ASA분급Ⅱ?Ⅳ급。채용수궤수자표법분위2조（ n＝15）：대조조（ C조）화우미탁미정조（ D조）。 D조마취유도후경10 min정맥수주우미탁미정부하량0．5μg∕kg，수후이0．5～1．0μg·kg－1·h－1적속솔정맥수주지수술결속。우마취유도후즉각（우미탁미정급약전）、CPB 30 min、CPB결속후30 min시채용경식관초성심동도측량CO화신혈류동역학지표：신동맥내경、신동맥평균혈류속도、신혈류량、신동맥박동지수화조력지수。우마취유도후즉각、CPB결속후2、12화24 h시취뇨동맥혈양，채용ELISA법측정혈장중성립세포백명효매상관지질운재단백화광억소C적농도。결과여C조비교，D조CPB 30 min화CPB결속후30 min시신혈류량증가，CPB결속후각시점혈장중성립세포백명효매상관지질운재단백농도강저（ P＜0．05），기여신혈류동역학지표、CO화혈장광억소C농도차이무통계학의의（ P＞0．05）。결론우미탁미정가증가CPB심장판막치환술환자신혈류량，산생신보호작용。
Objective To investigate the effects of dexmedetomidine on renal hemodynamics in patients undergoing cardiac valve replacement with cardiopulmonary bypass ( CPB) . Methods Thirty ASA physical status Ⅱ?Ⅳ patients of both sexes, aged 18-60 yr, weighing 42-68 kg, scheduled for elective cardiac valve replacement with CPB, were randomized into two groups ( n=15 each) using a random number table: control group ( group C ) and dexmedetomidine group ( group D ) . In group D, after induction of anesthesia, dexmedetomidine was given with a 0. 5μg∕kg loading bolus over 10 min, followed by an infusion of 0.5-1.0 μg·kg-1 ·h-1 throughout the surgery. Immediately after induction of anesthesia (before administration of dexmedetomidine), at 30 min of CPB, and at 30 min after the end of CPB, cardiac output and indexes of renal hemodynamics including the internal diameter of left renal artery, mean renal blood flow velocity, renal blood flow volume, and renal artery pulsatility index and resistance index were measured by transesophageal echocardiography. Immediately after induction of anesthesia, and at 2, 12 and 24 h after the end of CPB, arterial blood samples were collected for measurement of the concentrations of neutrophil gelatinase lipocalin?2 and cystatin C in plasma by enzyme?linked immunosorbent assay. Results Compared with group C, the renal blood flow volume was significantly increased at 30 min of CPB and 30 min after the end of CPB, the concentrations of neutrophil gelatinase lipocalin?2 in plasma were decreased at each time point after CPB, and no significant differences were found in the other indexes of renal hemodynamics, cardiac output and concentrations of cystatin C in plasma in group D. Conclusion Dexmedetomidine can increase renal blood flow volume and thus provides renoprotection in patients undergoing cardiac valve replacement with CPB.