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Effect of dexmedetomidine on renal function in patients with septic⁃associated acute kidney injury: A cohort study
Received date: 2023-10-21
Online published: 2024-05-21
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.
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 . DOI: 10.3969/j.issn.1006-5725.2024.10.016
| 1 | POSTON J T, KOYNERK J L. Sepsis associated acute kidney injury[J]. BMJ, 2019, 184(364):k4891. |
| 2 | 李晓玲,周文杰,邓伟,等. 凝血指标联合血清胱抑素C对脓毒症急性肾损伤患者预后的预测价值[J]. 实用医学杂志, 2023,39(1):81-85. |
| 3 | PEERAPORNRATANA S, MANRIQUE-CABALLERO C L, GOMEZ H, et al. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment[J]. Kidney Int, 2019,96(5):1083-1099. doi:10.1016/j.kint.2019.05.026 |
| 4 | SADJADI M, PORSCHEN C, VON GROOTE T, et al. Implementation of Nephroprotective Measures to Prevent Acute Kidney Injury in Septic Patients: A Retrospective Cohort Study[J]. Anesth Analg, 2023,137(6):1226-1232. doi:10.1213/ane.0000000000006495 |
| 5 | 刘丽霞,胡振杰. 脓毒症急性肾损伤血液净化治疗的现状与展望[J]. 中国实用内科杂志, 2023,43(12):989-995. |
| 6 | CHEN W Y, CAI L H, ZHANG Z H, et al. The timing of continuous renal replacement therapy initiation in sepsis-associated acute kidney injury in the intensive care unit: the CRTSAKI Study (Continuous RRT Timing in Sepsis-associated AKI in ICU): study protocol for a multicentre, randomised controlled trial[J]. BMJ Open, 2021, 11(2):e040718. doi:10.1136/bmjopen-2020-040718 |
| 7 | 于乐昌,杨立恒,张蔷. 右美托咪定对老年脓毒症机械通气患者炎症和预后的影响[J]. 天津医科大学学报, 2022,28(4):409-413. doi:10.3969/j.issn.1006-8147.2022.4.tianjykdxxb202204012 |
| 8 | 周文杰,张楠,杨海荣,等. 右美托咪定对脓毒症急性肾损伤大鼠肾功能保护作用机制研究[J]. 中国临床药理学杂志, 2022,38(13):1481-1485. |
| 9 | 万卿,钟毅,李依萍,等. 右美托咪定对脓毒症小鼠急性肾损伤的影响[J]. 临床麻醉学杂志, 2022,38(4):406-412. doi:10.12089/jca.2022.04.014 |
| 10 | 中国医师协会急诊医师分会,中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 中国急救医学, 2018,38(9):741-756. doi:10.3969/j.issn.1002-1949.2018.09.001 |
| 11 | KDIGO K. Acute Kidney Injury Work Group:KDIGO clinical practice guideline for acute kidney injury[J]. Kidney Int, 2012,2(1):1-138. |
| 12 | 江浩,郑贸根,朱超男,等. APACHEⅡ、ISS、SOFA评分对创伤继发ARDS严重程度及预后的预测价值比较[J]. 临床肺科杂志, 2018,23(11):2074-2078. doi:10.3969/j.issn.1009-6663.2018.11.034 |
| 13 | MANRIQUE-CABALLERO C L, DEL RIO-PERTUZ G, GOMEZ H. Sepsis-Associated Acute Kidney Injury[J]. Crit Care Clin, 2021,37(2):279-301. doi:10.1016/j.ccc.2020.11.010 |
| 14 | MA J, CHEN Q, LI J, et al. Dexmedetomidine-Mediated Prevention of Renal Ischemia-Reperfusion Injury Depends in Part on Cholinergic Anti-Inflammatory Mechanisms[J]. Anesth Analg,2020,130(4):1054-1062. doi:10.1213/ane.0000000000003820 |
| 15 | LI B Y, LIU Y, LI Z H, et al. Dexmedetomidine promotes the recovery of renal function and reduces the inflammatory level in renal ischemia-reperfusion injury rats through PI3K/Akt/HIF-1α signaling pathway[J]. Eur Rev Med Pharmacol Sci, 2020, 24(23):12400-12407. |
| 16 | TAO W H, SHAN X S, ZHANG J X, et al. Dexmedetomidine Attenuates Ferroptosis-Mediated Renal Ischemia/Reperfusion Injury and Inflammation by Inhibiting ACSL4 via α2-AR[J]. Front Pharmacol, 2022,14(13):782466. |
| 17 | 余黎媛, 凌斌, 修光辉. 右美托咪定对脓毒症肠屏障功能保护作用的研究进展[J]. 山东医药, 2021, 61(7):111-115. doi:10.3969/j.issn.1002-266X.2021.07.028 |
| 18 | 赵永华. 右美托咪定对脓毒症患者肾脏的保护作用临床研究[J]. 医学美学美容, 2020,29(10):6-7. |
| 19 | SI Y, BAO H, HAN L, et al.Dexmedetomidine attenuation of renal ischaemia- reperfusion injury requires sirtuin 3 activation[J]. Br J Anaesth, 2018, 121(6): 1260-1271. doi:10.1016/j.bja.2018.07.007 |
| 20 | XU Z, WANG D, ZHOU Z, et al.Dexmedetomidine attenuates renal and myocardial ischemia/reperfusion injury in a dose-dependent manner by inhibiting inflammatory response[J]. Ann Clin Lab Sci, 2019, 49(1): 31-35. |
| 21 | LOOMBA R S, VILLARREAL E G, DHARGALKAR J, et al. The effect of dexmedetomidine on renal function after surgery: A systematic review and meta-analysis[J]. J Clin Pharm Ther, 2021, 47(3): 287-297. doi:10.1111/jcpt.13527 |
| 22 | 王逸平,王林华,保鹏,等. 倾向性评分匹配评估右美托咪定对腹腔感染相关脓毒症患者术后炎症反应及肾损伤的影响[J].交通医学, 2023,37(1):49-53. |
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