目的 探讨右美托咪定对脓毒症急性肾损伤（AKI）患者的肾功能影响。 方法 采取前瞻性队列研究，选取2021年10月至2023年4月广东医科大学附属第二医院180例入住ICU治疗的脓毒症患者为研究对象。按照随机对照原则进行分组，将60例非AKI患者分为S-D组（n = 30，右美托咪定+常规治疗）和S组（n = 30，常规治疗），比较两组治疗后AKI的发生和病情评分。将120例AKI患者分为SA-D-RT组（n = 30，右美托咪定+血液净化+常规治疗）、SA-D组（n = 30，右美托咪定+常规治疗）、SA-RT组（n = 30，血液净化+常规治疗）和SA组（n = 30，常规治疗），比较四组患者治疗后的肾功能、炎症因子水平和病情变化。 结果 经治疗，S-D组患者的AKI发生率低于S组，S-D组患者治疗后第7天的APACHEⅡ评分、SOFA评分均低于S组（P < 0.05）。治疗第7天后，四组患者的Scr、BUN和Cys C水平较第1、3天均明显降低，且SA-D-RT组低于SA-D组、SA-RT组和SA组（P < 0.05）。治疗第7天后，四组患者的CRP、PCT、TNF-α、IL-6和IL-1β水平较第1、3天均明显降低，且SA-D-RT组低于SA-D组、SA-RT组和SA组（P < 0.05）。治疗第7天后，四组患者的APACHEⅡ评分、SOFA评分较第1、3天均明显降低，且SA-D-RT组低于SA-D组、SA-RT组和SA组（P < 0.05）。 结论 右美托咪定应用于脓毒症的治疗中，可有效降低AKI的发生率，影响SAKI患者肾功能、炎症因子各项指标在血清中的表达水平，改善患者的病情。

Objective To investigate the effect of dexmedetomidine on renal function in patients with septic?associated acute kidney injury （SAKI）. Methods A prospective cohort study was conducted in 180 patients with sepsis admitted to ICU in the Second Affiliated Hospital of Guangdong Medical University from October 2021 to April 2023. According to the principle of randomized controlled trials， 60 non? acute kidney injury （AKI） patients were divided into S?D group （n = 30， dexmedetomidine + conventional treatment） and S group （n = 30， conventional treatment）， and the occurrence and disease score of AKI after treatment were compared between the two groups. A total of 120 AKI patients were divided into SA?D?RT group （n = 30， dexmedetomidine + blood purification + conventional treatment）， SA?D group （n = 30， dexmedetomidine + conventional treatment）， SA?RT group （n = 30， blood purification + conventional treatment） and SA group （n = 30， conventional treatment）. Renal function， inflammatory factor level and disease change of the four groups were compared after treatment. Results After treatment， the incidence of AKI in S?D group was lower than that in S group， and the APACHEII score and SOFA score in S?D group were lower than those in S group on the 7th day after treatment （P < 0.05）. After 7 days of treatment， the level of Scr， BUN and CysC in the 4 groups was significantly lower than that on the 1st and 3rd day， and those in the SA?D?RT group were lower than those in the SA?D group， SA?RT group and SA group （P < 0.05）. After 7 days of treatment， the level of CRP， PCT， TNF?α， IL?6 and IL?1β in four groups was significantly decreased compared with on the 1st and 3rd day， and the level of CRP， PCT， TNF?α， IL?6 and IL?1β in SA?D?RT group was lower than that in SA?D group， SA?RT group and SA group （P < 0.05）. After 7 days of treatment， the APACHEII score and SOFA score of the four groups were significantly lower than on the 1st and 3rd day， and the scores of the SA?D group were lower than those of the SA?D group， the SA?RT group and the SA group （P < 0.05）. Conclusion Dexmedetomidine can effectively reduce the incidence of AKI， affect the expression level of renal function markers and inflammatory factors in serum of SAKI patients， and improve the condition of patients.