南方医科大学学报

南方医科大学学报 ›› 2023, Vol. 43 ›› Issue (4): 654-659.doi: 10.12122/j.issn.1673-4254.2023.04.21

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右美托咪定不能降低腹腔镜下根治性肾切除术后急性和慢性肾脏病的发病率：基于倾向性评分匹配法

苏雨薇，孙 闻，王 迪，董钰妍，丁 莹，徐龙河，刘永哲   

  1. 中国人民解放军总医院第三医学中心麻醉科，北京 100059；山西医科大学麻醉学院，山西 太原 030001；锦州医科大学研究生学院，辽宁 锦州 121001
  • 出版日期:2023-04-20 发布日期:2023-05-16

Dexmedetomidine can not reduce the incidence of acute and chronic kidney disease after laparoscopic radical nephrectomy: a propensity score matching-based analysis

Su Yuwei, Sun Wen, WANG Di, Dong Yuyan, DING Ying, XU Longhe, LIU Yongzhe   

  1. Department of Anesthesiology, the Third Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100059, China; College of Anesthesia, Shanxi Medical University, Taiyuan 030001, China; Graduate School of Jinzhou Medical University, Jinzhou 121001, China
  • Online:2023-04-20 Published:2023-05-16

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摘要： 目的 研究右美托咪定（DEX）对腹腔镜下根治性肾切除术后肾功能的影响。方法 选取2020年11月~2022年6月解放军总医院第三医学中心泌尿外科收治的282例接受腹腔镜下根治性肾切除术（LRN）的肾细胞癌（RCC）患者的临床资料。根据术中是否使用DEX分为右美托咪定组（D组）和对照组（C组），经倾向性评分匹配后，每组最终入组99例，比较两组患者急性肾损伤（AKI）；收集到其中51例患者术后3个月~1年内的血肌酐（sCr），其中D组26例，C组25例，比较两组患者慢性肾脏病（CKD）的发生率。结果 经倾向性评分匹配和显著协变量调整后，两组患者术后sCr、术后胱抑素C（CysC）、术后β2微球蛋白（β2-MG）、术后血红蛋白（Hb）、术后C反应蛋白（CRP）、拔管时间、AKI发生率、住院时间均无统计学意义（P>0.05）；D组的术中尿量显著多于C组，差异有统计学意义（P<0.05）。术后AKI和CKD有关联性，差异有统计学意义（P<0.05）；两组患者CKD发生率无统计学意义（P>0.05）。结论 DEX不能降低LRN术后AKI发生率和CKD的发生率。

关键词: 右美托咪定；根治性肾切除术；急性肾损伤；倾向性评分匹配

Abstract: Objective To investigate the effect of dexmedetomidine (DEX) on renal function after laparoscopic radical nephrectomy. Methods We reviewed the clinical data of 282 patients with renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy (LRN) in the Department of Urology, Third Medical Center of PLA General Hospital from November, 2020 and June, 2022. According to whether DEX was used during the operation, the patients were divided into DEX group and control group, and after propensity score matching, 99 patients were finally enrolled in each group. The incidence of acute kidney injuries were compared between the two groups. Serum creatinine (sCr) data within 3 months to 1 year after the operation were available in 51 patients, including 26 in DEX group and 25 in the control group, and the incidence of chronic kidney disease (CKD) was compared between the two groups. Results After propensity score matching and adjustment for significant covariates, there were no significant differences in postoperative levels of sCr, cystatin C (CysC), β2-microglobulin (β2-MG), hemoglobin (Hb), or C-reactive protein (CRP), extubation time, incidence of AKI, or length of hospital stay between the two groups (P>0.05). The intraoperative urine volume was significantly higher in DEX group than in the control group (P<0.05). A significant correlation between AKI and CKD was noted in the patients (P<0.05). The incidence of CKD did not differ significantly between the two groups (P>0.05). Conclusion DEX can not reduce the incidence of AKI or CKD after LRN.

Key words: dexmedetomidine; radical nephrectomy; acute kidney injury; propensity score matching