右美托咪定对糖尿病肾病患者肾移植围手术期血糖的影响

Effect of Dexmedetomidine on blood glucose of renal transplantation patients with diabetic nephropathy during perioperative period

摘要:

目的 评价右美托咪定对糖尿病肾病终末期接受同种异体肾移植术麻醉的有效性与安全性。方法 选取2015年2月—2016年2月在广州医科大学附属第二医院接受肾移植术的糖尿病肾病患者60例，随机盲法分为右美托咪定组（D组）和对照组（C组），每组30例。D组于麻醉诱导前10?min给予右美托咪定（1?μg/kg）， 10?min内泵注完毕，麻醉维持阶段以0.3 μg/（kg·h）泵注，术毕前1?h停止泵注；C组以同样的方式、时点给予生理盐水，两组麻醉诱导及维持药物相同。观察并记录两组患者给药前（T0），给予负荷量后（T1）、插管即刻（T2）、停用右美托咪定30 min（T3）、在PACU拔管前（T4）、拔管后（T5）各时时点的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、血糖及脑电双频指数（BIS）。结果 两组不同时间点的血糖、MAP、HR及BIS值比较有差异（均P?<0.05）；两组间血糖、MAP、HR比较有差异（均P?<0.05），BIS值比较无差异（P?> 0.05）；两组血糖、MAP、HR变化趋势有差异（均P?<0.05），两组BIS值变化趋势无差异（P?>0.05）。结论 右美托咪定可以安全有效地应用于糖尿病肾病同种异体肾移植术中，且可以改善患者围术期血流动力学变化。

Abstract:

Objective To evaluate the efficacy and safety of Dexmedetomidine in the end-stage renal anesthesia for diabetic nephropathy (DN). Methods Sixty patients with diabetic nephropathy who underwent renal transplantation at The Second Affiliated Hospital of Guangzhou Medical University from February 2015 to February 2016 were randomly divided into Dexmedetomidine group (group D) and control group (group C), 30 cases in each group. Group D was given Dexmedetomidine (1?μg/kg) 10 min before anesthesia induction, pumping was completed within 10 min, pumping was performed at 0.3?μg/(kg?h) during the anesthesia maintenance phase, and the pump was stopped 1?h before the operation. Group C was given normal saline in the same manner and at the same time, and the two groups of anesthesia induction and maintenance drugs were the same. The mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) were observed and recorded before administration (T0), 10 min after loading dose administration (T1), intubation time (T2), 30?min after stopping using Dexmedetomidine (T3), before the extubation (T4) and after the extubation (T5). Results There were significant differences in blood glucose, MAP, HR and BIS between the two groups at different time points (P??0.05). There were differences in the changes of blood glucose, MAP and HR between the two groups (P??0.05). Conclusions Dexmedetomidine can be safely and effectively used in allogeneic renal transplantation for diabetic nephropathy, and it can improve perioperative hemodynamic changes.