BACKGROUND Acute kidney injury (AKI) is a frequent and serious complication after aortic surgery requiring cardiopulmonary bypass (CPB). Dexmedetomidine, a selective α-2 adrenoreceptor agonist, may reduce AKI because of its sympatholytic and anti-inflammatory effects against ischaemia-reperfusion injury. We investigated the effect of dexmedetomidine administration on AKI after aortic surgery requiring CPB in a placebo-controlled randomised controlled trial. METHODS A total of 108 patients were randomly assigned to an infusion of dexmedetomidine or saline at a rate of 0.4 μg kg-1 h-1 for 24 h starting after anaesthetic induction. The primary outcome was the incidence of AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The secondary outcomes included delirium and major morbidity. Safety outcomes were drug-related adverse events (bradycardia, hypotension). RESULTS AKI occurred in 7/54 (13%) subjects randomised to dexmedetomidine, compared with 17/54 (31%) subjects randomised to saline infusion (odds ratio=0.32; 95% confidence interval [CI], 0.12-0.86; P=0.026). Secondary outcomes, including stroke, mortality, and delirium, were similar between subjects randomised to dexmedetomidine (16/54 [30%] or saline control (22 [41%]; odds ratio=0.61 [95% CI, 0.28-1.36]). The incidence of bradycardia and hypotension was similar between groups (14/54 (26%) vs. 17/54 (32%) (odds ratio:0.76 (95%CI:0.33-1.76) and 29/54 (54%) vs. 36/54 (67%) (odds ratio:0.58 (95%CI:0.27-1.26), respectively). The length of hospital stay was shorter in the dexmedetomidine group (12 [10-17] days) vs saline control (15 [11-21] days; P=0.039). CONCLUSIONS Pre-emptive dexmedetomidine administration for 24 h starting after induction of anaesthesia reduced the incidence of AKI after aortic surgery requiring CPB, without any untoward side-effects related to its sedative or sympatholytic effects. CLINICAL TRIAL REGISTRATION NCT02607163 (www.ClinicalTrials.gov).

中文翻译：

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右美托咪定对主动脉手术后急性肾损伤的影响：一项单中心、安慰剂对照、随机对照试验。


背景急性肾损伤（AKI）是需要体外循环（CPB）的主动脉手术后常见且严重的并发症。右美托咪定是一种选择性 α-2 肾上腺素受体激动剂，由于其抗缺血再灌注损伤的交感神经和抗炎作用，可能会减少 AKI。我们在一项安慰剂对照随机对照试验中研究了右美托咪定对需要 CPB 的主动脉手术后 AKI 的影响。方法 共有 108 名患者被随机分配接受右美托咪定或生理盐水输注，剂量为 0.4 μg kg-1 h-1，持续 24 h，从麻醉诱导后开始。主要结局是 AKI 的发生率，根据肾脏疾病：改善全球结局 (KDIGO) 标准定义。次要结局包括谵妄和主要发病率。安全性结果是与药物相关的不良事件（心动过缓、低血压）。结果 随机接受右美托咪定的受试者中有 7/54 (13%) 发生 AKI，而随机接受盐水输注的受试者中有 17/54 (31%) 发生 AKI（比值比 = 0.32；95% 置信区间 [CI]，0.12-0.86；P= 0.026）。次要结局，包括中风、死亡率和谵妄，在随机分配至右美托咪定 (16/54 [30%]) 或盐水对照 (22 [41%]；比值比 = 0.61 [95% CI，0.28-1.36]) 的受试者之间相似组间心动过缓和低血压的发生率相似（14/54 (26%) 与 17/54 (32%)（比值比：0.76 (95% CI:0.33-1.76) 和 29/54 (54%)）与 36/54 (67%)（比值比分别为 0.58 (95%CI:0.27-1.26)）相比，右美托咪定组的住院时间较短（12 [10-17] 天）。 （15 [11-21] 天；P=0.039）。 结论 麻醉诱导后 24 小时预先给予右美托咪定可降低需要 CPB 的主动脉手术后 AKI 的发生率，且无任何与其镇静或抗交感神经作用相关的不良副作用。临床试验注册 NCT02607163 (www.ClinicalTrials.gov)。