Purpose: Postoperative acute kidney injury (AKI) is a frequent complication in elderly patients that increases morbidity and mortality. Approximately 1.7 million people die from AKI worldwide every year. Dexmedetomidine (Dex) is often used as an adjunct to multimodal analgesia. Our study investigated whether Dex could safely decrease the incidence of AKI in elderly patients undergoing major joint replacement.
Methods: A single-center retrospective study was conducted in patients aged > 65 years undergoing major joint replacement. Propensity score–matching analysis was used, and a total of 1,006 patients were matched successfully. The primary outcome was the incidence of postoperative AKI. Secondary outcomes included perioperative adverse complications, opioid consumption, time to extubation, and length of hospital stay.
Results: Among the 1,006 patients included, postoperative AKI occurred in 9.3% (n=94). The Dex group (perioperative Dex infusion) had lower incidence of postoperative AKI than the control group (7.2% vs 11.5%, P=0.017). Compared with the control group, the Dex group had less opioid consumption (P< 0.05), reduced time to extubation (P=0.004), and shorter length of hospital stay (P=0.001). The Dex group also showed higher incidence of bradycardia (20.1% vs 15.1%, P=0.038). There were no differences in intraoperative hypotension (19.5% vs 17.5%), postoperative nausea and vomiting (4.2% vs 5.4%), time in PACU (45.0± 6.4 vs 45.5± 6.2 minutes), or rate of ICU admission (9.7% vs 11.1%) between the Dex group and control group (All P> 0.05).
Conclusion: This retrospective study showed Dex infusion in elderly patients undergoing major joint replacement was associated with lower incidence of postoperative AKI, less opioid consumption, and shorter extubation time and hospital stay. However, the Dex group had higher incidence of bradycardia. We found no statistical differences in other perioperative adverse complications between the groups.

Keywords: dexmedetomidine, acute kidney injury, elderly patients, joint replacement


中文翻译：

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右美托咪定输注对接受大关节置换的老年患者术后急性肾损伤的影响：一项回顾性队列研究

目的：术后急性肾损伤（AKI）是老年患者常见的并发症，会增加发病率和死亡率。全世界每年约有 170 万人死于 AKI。右美托咪定 (Dex) 通常用作多模式镇痛的辅助手段。我们的研究调查了 Dex 是否可以安全地降低接受大型关节置换术的老年患者的 AKI 发病率。
方法：一项单中心回顾性研究在年龄 > 65 岁接受大关节置换的患者中进行。使用倾向评分匹配分析，共有 1,006 名患者成功匹配。主要结果是术后 AKI 的发生率。次要结局包括围手术期不良并发症、阿片类药物消耗、拔管时间和住院时间。
结果：在纳入的 1,006 名患者中，术后 AKI 发生率为 9.3%（n=94）。Dex组（围手术期Dex输注）术后AKI发生率低于对照组（7.2% vs 11.5%，P =0.017）。与对照组相比，Dex组阿片类药物消耗量减少（P < 0.05），拔管时间缩短（P=0.004），住院时间更短（P =0.001）。Dex 组的心动过缓发生率也较高（20.1% vs 15.1%，P = 0.038）。术中低血压（19.5% 对 17.5%）、术后恶心和呕吐（4.2% 对 5.4%）、PACU 时间（45.0±6.4 对 45.5±6.2 分钟）或 ICU 入院率（9.7% 对11.1%）在 Dex 组和对照组之间（所有P > 0.05）。
结论：这项回顾性研究表明，在接受大关节置换的老年患者中输注 Dex 与较低的术后 AKI 发生率、较少的阿片类药物消耗、较短的拔管时间和住院时间相关。然而，Dex 组的心动过缓发生率较高。我们发现组间其他围手术期不良并发症无统计学差异。

【关键词】：右美托咪定 急性肾损伤 老年患者 关节置换