右美托咪定对脓毒症急性肾损伤患者的肾功能影响的队列研究

doi:10.3969/j.issn.1006-5725.2024.10.016

Abstract

Abstract:

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.

Key words: dexmedetomidine, sepsis acute kidney injury, kidney function, inflammatory factors, cohort study

CLC Number:

Yinbi ZHENG,Yiming SHAO,Zhaoji LI,Shiting LI,Mingdi CHEN,Wenchi ZENG,Hongyu. DONG. Effect of dexmedetomidine on renal function in patients with septic⁃associated acute kidney injury： A cohort study[J]. The Journal of Practical Medicine, 2024, 40(10): 1423-1428.

Figures/Tables 5

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Tab.5

References 22

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组别	例数	发生	未发生
S-D组	30	14（46.67）	16（53.33）
S组	30	22（73.33）	8（26.67）
χ ² 值			4.444
P值			0.035

组别	例数	APACHEII评分			SOFA评分
组别	例数	第1天	第3天	第7天	第1天	第3天	第7天
S-D组	30	21.37 ± 5.12	14.03 ± 3.02	10.13 ± 2.78	7.83 ± 3.52	6.07 ± 2.58	4.23 ± 1.83
S组	30	20.90 ± 6.89	16.33 ± 4.30	12.20 ± 3.38	7.47 ± 3.64	6.35 ± 2.77	5.37 ± 1.50
F值		0.089	5.741	6.704	0.157	0.149	6.884
P值		0.767	0.020	< 0.001	0.693	0.701	0.011
F_组间/P_组间		4.741/< 0.001			3.756/< 0.05
F_时间/P_时间		72.769/< 0.001			18.404/< 0.001
F_交互/P_交互		1.285/0.175			1.402/0.333

组别	例数	Scr（μmol/L）			BUN（mmol/L）			Cys C（mg/L）
组别	例数	第1天	第3天	第7天	第1天	第3天	第7天	第1天	第3天	第7天
SA-D-RT组	30	221.59 ± 21.81	203.71 ± 18.65	176.20 ± 20.35	9.67 ± 2.23	8.01 ± 1.42	6.32 ± 1.21	2.20 ± 0.24	1.32 ± 0.12	0.83 ± 0.09
SA-D组	30	227.64 ± 18.72	215.32 ± 15.52	188.34 ± 18.25	9.45 ± 1.92	8.89 ± 1.51	7.49 ± 1.48	2.23 ± 0.19	1.78 ± 0.15	1.13 ± 0.08
SA-RT组	30	229.74 ± 25.83	216.77 ± 14.85	183.79 ± 17.94	9.80 ± 2.37	8.91 ± 1.48	7.38 ± 2.10	2.19 ± 0.17	1.71 ± 0.11	1.05 ± 0.11
SA组	30	231.28 ± 24.68	220.38 ± 19.40	190.17 ± 23.49	9.58 ± 1.46	9.05 ± 2.19	8.03 ± 1.66	2.25 ± 0.26	1.92 ± 0.15	1.53 ± 0.13
F值		2.428	5.268	2.868	0.151	2.398	5.674	0.308	104.087	234.170
P值		0.069	0.002	0.040	0.929	0.072	0.001	0.819	< 0.001	< 0.001
F_组间/P_组间		7.476/< 0.001			4.009/< 0.001			121.027/< 0.001
F_时间/P_时间		103.812/< 0.001			51.697/< 0.001			1 506.959/< 0.001
F_交互/P_交互		1.139/0.254			1.505/0.177			24.446/< 0.001

组别	例数	CRP（mg/L）			PCT（ng/mL）
组别	例数	第1天	第3天	第7天	第1天	第3天	第7天
SA-D-RT组	30	91.25 ± 25.38	73.95 ± 18.83	64.28 ± 12.18	14.35 ± 5.37	11.26 ± 4.59	7.21 ± 3.58
SA-D组	30	93.12 ± 20.34	81.31 ± 20.64	72.33 ± 15.25	15.73 ± 6.03	12.82 ± 3.60	9.62 ± 4.25
SA-RT组	30	92.63 ± 19.45	80.91 ± 15.50	71.48 ± 14.95	15.83 ± 5.74	12.19 ± 4.33	9.30 ± 4.13
SA组	30	95.37 ± 22.27	86.58 ± 19.40	80.64 ± 19.27	14.13 ± 5.18	13.01 ± 4.99	10.46 ± 3.92
F值		0.183	2.309	5.521	0.760	0.956	1.642
P值		0.908	0.080	0.001	0.929	0.072	0.001
F_组间/P_组间		4.627/< 0.001			4.578/< 0.001
F_时间/P_时间		45.121/< 0.001			52.901/< 0.001
F_交互/P_交互		0.613/0.733			0.663/0.645
组别	例数	TNF-α（ng/L）			IL-6（ng/L）
组别	例数	第1天	第3天	第7天	第1天	第3天	第7天
SA-D-RT组	30	92.35 ± 15.94	78.55 ± 14.16^a	64.58 ± 11.47	173.51 ± 26.64	131.02 ± 22.57	91.25 ± 18.97
SA-D组	30	91.48 ± 13.21	86.44 ± 18.89	74.21 ± 12.25	178.32 ± 28.34	151.41 ± 28.11	119.40 ± 21.65
SA-RT组	30	94.71 ± 15.07	83.47 ± 15.93	71.30 ± 15.58	175.91 ± 22.09	150.27 ± 20.83	115.00 ± 19.75
SA组	30	93.43 ± 17.54	90.56 ± 20.77	82.10 ± 12.76	176.55 ± 24.66	161.66 ± 18.36	130.56 ± 22.78
F值		0.243	2.469	9.215	0.182	9.475	18.928
P值		0.866	0.066	< 0.001	0.908	< 0.001	< 0.001
F_组间/P_组间		6.352/< 0.001			20.167/< 0.001
F_时间/P_时间		50.701/< 0.001			204.879/< 0.001
F_交互/P_交互		1.753/0.110			3.274/0.004
组别	例数	IL-1β（ng/L）
组别	例数	第1天	第3天	第7天
SA-D-RT组	30	42.70 ± 10.25	34.59 ± 9.28	30.95 ± 7.47
SA-D组	30	43.59 ± 9.58	39.45 ± 8.64	35.55 ± 9.82
SA-RT组	30	46.33 ± 12.05	38.80 ± 10.87	36.29 ± 10.86
SA组	30	44.77 ± 12.32	41.27 ± 7.43	38.56 ± 8.51
F值		0.600	2.867	3.571
P值		0.616	0.040	0.016
F_组间/P_组间		5.175/< 0.001
F_时间/P_时间		25.583/< 0.001
F_交互/P_交互		0.597/0.732

组别	例数	APACHEⅡ评分			SOFA评分
组别	例数	第1天	第3天	第7天	第1天	第3天	第7天
SA-D-RT组	30	20.47 ± 5.24	16.33 ± 4.51	11.00 ± 4.14	11.23 ± 2.11	9.04 ± 3.51	7.20 ± 2.44
SA-D组	30	19.53 ± 6.54	17.93 ± 4.27	13.23 ± 3.96	11.10 ± 3.26	9.43 ± 3.11	8.10 ± 2.44
SA-RT组	30	21.03 ± 5.47	17.27 ± 5.63	13.80 ± 4.32	11.37 ± 3.44	9.30 ± 2.94	8.13 ± 1.92
SA组	30	21.13 ± 6.16	18.93 ± 6.67	15.43 ± 5.81	11.43 ± 3.90	10.00 ± 3.34	9.00 ± 2.83
F值		0.469	1.257	4.741	0.062	0.477	0.699
P值		0.705	0.293	0.004	0.980	0.699	0.046
F_组间/P_组间		3.144/< 0.05			3.74/< 0.05
F_时间/P_时间		60.282/< 0.001			33.297/< 0.001
F_交互/P_交互		0.978/0.441			0.380/0.892

Effect of dexmedetomidine on renal function in patients with septic⁃associated acute kidney injury： A cohort study

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