【摘要】 目的:探讨右美托咪定对先心病患儿体外循环（cardiopulmonary bypass,CPB）术后发生急性肾损伤（acute kidney injury,AKI）的影响及其相关机制。方法:选取2017年6月～2019年6月于本院行CPB手术的先心病患儿168例作为研究对象,采用随机数字表法分为对照组和观察组,每组84例。麻醉诱导前15 min,观察组患儿静脉注射右美托咪定负荷剂量1μg/（kg·h）,随后以0.5μg/（kg·h）速度持续泵入至术后12 h;对照组仅给予静脉泵入生理盐水至术后12 h。检测两组患儿在术前（T₀）、麻醉诱导后30 min（T₁）、术后24 h（T₂）、术后48 h（T₃）及术后72 h（T₄）血清肌酐、核转录因子-κB（nuclear transcription factor-κB,NF-κB）、白介素1β（interleukin-1β,IL-1β）和肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）表达水平及外周血单个核细胞（PBMC）中Toll样受体3⁺（TLR3⁺）细胞百分比的差异,并评估两组患儿AKI发生率的差异。结果:在T₀和T₁时间点,两组患儿外周血PBMC中TLR3⁺细胞百分比无统计学差异;在T₂、T₃和T₄时间点,观察组患儿外周血PBMC中TLR3⁺细胞百分比均低于对照组,具有统计学差异（P<0.05）。T₃和T₄时间点,观察组患儿血清肌酐水平低于对照组,具有统计学差异（P<0.05）;T₂、T₃和T₄时间点,观察组患儿血清NF-κB水平低于对照组,但血清IL-1β和TNF-α表达水平仅在T₃和T₄时间点低于对照组,具有统计学差异（P<0.05）。术后48 h,观察组AKI发生率低于对照组（5.95%vs19.05%）,具有统计学差异（P=0.010）。结论:右美托咪定预处理能降低CPB术后患儿AKI的发生风险,可能与抑制TLR3/NF-κB及其下游的炎症介质有关。更多还原

【Abstract】 Objective: To investigate the effect of dexmedetomidine on acute renal injury（ AKI） after cardiopulmonary bypass（CPB） in children with congenital heart disease and its potential mechanism.Methods: A total of 168 children with congenital heart disease undergoing CPB between June 2017 and June 2019 in our hospital were collected as research subjects. All children were divided into control group and observation group by random number table method with 84 cases in each group. About 15 min before anesthesia induction, the children in observation group were given dexmedetomidine with loading dose of 1 μg/（kg·h）, and then pumped at the rate of 0.5 μg/（kg·h）continuously to 12 h after operation. The children in the control group were only given normal saline intravenously continuously to 12 h after operation. The serum creatinine, nuclear transcription factor-κB（NF-κB）, interleukin-1β（IL-1β）, tumor necrosis factor-α （TNF-α） levels, percentage of Toll like receptor 3⁺（TLR3⁺） cell in peripheral blood mononuclear cell（ PBMC） were measured and compared before operation（ T₀）, 30 min after anesthesia induction（T₁）, 24 h（T₂）, 48 h（T₃） and 72 h（T₄） after operation. The incidence of AKI in two groups was compared.Results: At the time point of T₀ and T₁, there was no significant difference in the percentage of TLR3⁺cells in PBMC between the two groups. At the time point of T₂, T₃ and T₄, the percentage of TLR3⁺cells in PBMC in observation group was significantly lower than the control group with statistical difference（P< 0. 05）. At the time point of T₃ and T₄, the serum creatinine levels in the observation group was significantly lower than the control group with statistical difference（P< 0. 05）. At the time point of T₂, T₃ and T₄, the serum NF-κB levels in the observation group was significantly lower than the control group and serum levels IL-1β and TNF-α were significantly lower than the control group only at the time points of T₃ and T₄ with statistical difference（P<0. 05）. The incidence of AKI in observation group was significantly lower than that in the control group at 48 h after operation（5. 95%vs19. 05%） with statistical difference（P= 0. 010）.Conclusion: Dexmedetomidine pretreatment can significantly reduce the risk of AKI in children after CPB, which may be related to the inhibition of TLR3/NF-κB signaling pathway and its downstream inflammatory factors.更多还原