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Effect of dexmedetomidine on acute kidney injury after aortic surgery: a single-centre, placebo-controlled, randomised controlled trial.
British Journal of Anaesthesia ( IF 9.1 ) Pub Date : 2020-01-29 , DOI: 10.1016/j.bja.2019.12.036
Sarah Soh 1 , Jae-Kwang Shim 1 , Jong-Wook Song 1 , Jae-Chan Bae 2 , Young-Lan Kwak 1
Affiliation  

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:


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)。
更新日期:2020-01-30
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