CAJ | 학술논문

目的：观察妇科恶性肿瘤腹腔镜手术中复合使用不同剂量的右美托咪定对围术期患者肾功能的影响。方法随机将患者分为对照组、研究组1、研究组2、研究组3。研究组于麻醉诱导时予0．4μg/(kg·h)负荷剂量右美托咪定静脉泵注10min 后,分别以0．1μg/(kg·h)(研究组1)、0．2μg/(kg·h)(研究组2)、0．4μg/(kg·h)(研究组3)持续静脉泵注至术毕。观察各组患者术中不同时间点的心率、平均动脉压,尿量及人中性粒细胞明胶酶相关性脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)的改变。结果气腹120 min 内尿量,研究组2和研究组3高于对照组及研究组1,差异有统计学意义(P <0．01),研究组3高于研究组2,差异有统计学意义(P <0．001)；恢复期120 min 内尿量,研究组3术后高于其余组,差异有统计学意义(P <0．05),其余各组间差异无统计学意义；研究组2和研究组3术后血浆NGAL 水平低于研究组1和对照组,差异有统计学意义(P <0．001),而相应各两组间差异无统计学意义(P >0．5)。结论右美托咪定用于妇科恶性肿瘤腹腔镜手术增加术中及术后恢复期尿量,抑制 NGAL 的升高,并且该作用存在剂量依赖性。
목적：관찰부과악성종류복강경수술중복합사용불동제량적우미탁미정대위술기환자신공능적영향。방법수궤장환자분위대조조、연구조1、연구조2、연구조3。연구조우마취유도시여0．4μg/(kg·h)부하제량우미탁미정정맥빙주10min 후,분별이0．1μg/(kg·h)(연구조1)、0．2μg/(kg·h)(연구조2)、0．4μg/(kg·h)(연구조3)지속정맥빙주지술필。관찰각조환자술중불동시간점적심솔、평균동맥압,뇨량급인중성립세포명효매상관성지질운재단백(neutrophil gelatinase associated lipocalin,NGAL)적개변。결과기복120 min 내뇨량,연구조2화연구조3고우대조조급연구조1,차이유통계학의의(P <0．01),연구조3고우연구조2,차이유통계학의의(P <0．001)；회복기120 min 내뇨량,연구조3술후고우기여조,차이유통계학의의(P <0．05),기여각조간차이무통계학의의；연구조2화연구조3술후혈장NGAL 수평저우연구조1화대조조,차이유통계학의의(P <0．001),이상응각량조간차이무통계학의의(P >0．5)。결론우미탁미정용우부과악성종류복강경수술증가술중급술후회복기뇨량,억제 NGAL 적승고,병차해작용존재제량의뢰성。
Objective To explore the effect of different dose of dexmedetomidine on the perioperative renal function in patients undergoing resection surgery for gynecologic malignant tumors. Methods One hundred patients were assigned randomly into 4 groups:control group, study group 1, study group 2, and study group 3. Patients in the study groups were administered 0. 4μg/ (kg·h) of dexmedetomidine for 10 min during the anesthesia induction, and were infused intravenously with dexmedetomi-dine at 0. 1 μg/ (kg·h)(study group 1), 0. 2 μg/ (kg·h)(study group 2), 0. 4 μg/ (kg·h)(study group 3)until the surgery completed. The values of HR, MAP, urine volume and neutrophil gelatinase associated lipocalin(NGAL)at different time points were recorded. Results Urine volume within 120 min after the pneumoperitoneum inflation in study group 2 and study group 3 were higher than in study group 1 and control group, and that in study group 3 was higher than in study group 2(P < 0. 001). U-rine volume within 120 min after the surgery completeness in study group 3 was higher than in other three groups(P < 0. 05), and no difference was found in urine volume among the control group, study group 1 and study group 2. NGAL in study group 2 and study group 3 were higher than in study group 1 and control group(P < 0. 001), and there was no difference between study group 2 and study group 3 as well as between study group 1 and control group. Conclusion In patients undergoing laparoscopic resection surgery for gynecologic malignant tumors, dexmedetomidine could improve the intraoperative hemodynamic response as well as perioperative renal function indicated by promoting urine production and alleviating the NGAL elevation caused by surgery, and this effect is in a manner of dose dependent.