西南医科大学学报2025，Vol.48Issue(6)：650-656,7.DOI:10.3969/j.issn.2096-3351.2025.06.016
不同剂量右美托咪定对改善脓毒血症相关急性肾损伤患者预后的临床分析
Clinical Analysis of Different Doses of Dexmedetomidine on Improving Prognosis of Patients with Sepsis-Related Acute Kidney Injury
摘要
Abstract
Objective To investigate the effects of different doses of dexmedetomidine(DEX)on renal function and hospitalization prognosis in patients with sepsis-associated acute kidney injury(SAKI).Methods A retrospective analysis of clinical data from 110 patients with severe acute kidney injury(SAKI)admitted to the Department of Critical Care Medicine at the Second Affiliated Hospital of Zhengzhou University between July 2021 and December 2024.Patients were divided into a low-dose group(0.25～0.56 µg·kg⁻¹·h-1,n=62)and a high-dose group(0.56～0.75 µg·kg⁻¹·h-1,n=48)based on the average daily dose of DEX administered.Statistical analysis was performed using SPSS 22.0 software.Measurement data that passed the Shapiro-Wilk normality test were compared between groups using the independent samples t-test.Repeated measures data were analyzed by analysis of variance(with Greenhouse-Geisser correction and Bonferroni post-hoc test when necessary).Categorical data were compared using the chi-square test.The predictive value of dexmedetomidine(DEX)dose for ICU outcomes was analyzed by plotting receiver operating characteristic(ROC)curves.Results Comparisons of baseline characteristics including gender,age,and BMI between the two patient groups showed no statisti-cally significant differences(P>0.05).With prolonged medication duration,both groups showed significant decreases in APACHEⅡscores,SOFA scores,serum creatinine(Scr,µmol/L),blood urea nitrogen(BUN,mmol/L),C-reactive protein(CRP,µg/mL),procalcitonin(PCT,ng/mL),urinary albumin(µg/mL),neutrophil gelatinase-associated lipocalin(NGAL,ng/mL),and β2-microglobulin(β2-MG,µg/mL)(time effect F=45.6～145.2,P<0.001),while 24-hour urine volume(mL)significantly increased.By treatment day 5(T2),the high-dose group exhibited significantly lower APACHEⅡ scores(11.07±0.75)and SOFA scores(10.37±0.68)compared to the low-dose group(13.67±0.86 and 12.39±0.73,respectively).In terms of renal function and inflammatory markers,the high-dose group exhibited significantly lower levels of Scr(146.28±36.49),BUN(10.67±3.75),CRP(13.20±2.87),PCT(9.74±1.47),NGAL(350.84±86.37),urinary albumin(35.20±10.82),and β2-MG(2.85±0.45)compared to the low-dose group(179.29±30.84,13.88±2.74,18.37±3.05,12.67±1.95,478.92±94.65,41.28±15.72,3.48±0.58,respectively).Conversely,the 24-hour urine volume in the high-dose group(794.20±138.24)was significantly higher than that in the low-dose group(587.39±100.39).All these differences were statistically significant(P<0.05).ROC curve analysis indicates that DEX dosage holds significant predictive value for continuous renal replacement therapy(CRRT)requirements during hospitalization,with an area under the curve(AUC)of 0.830(95％CI:0.673～0.926)and an optimal cutoff value of 0.43 µg·kg-1·h-1.Additionally,this dosage demonstrated predictive capability for transferring to a general ward within 2 weeks(AUC=0.700,95％CI:0.659～0.885),with an optimal cutoff value of 0.56 µg·kg-1·h-1.Conclusion High-dose DEX(0.56～0.75 µg·kg-1·h-1)demonstrated superior efficacy compared to low-dose DEX(0.25～0.56 µg·kg-1·h-1)in alleviating sepsis severity,preserving renal function,and improving clinical outcomes in SAKI patients.关键词
右美托咪定/脓毒症相关急性肾损伤/ICU住院预后/尿蛋白Key words
Dexmedetomidine/Sepsis-associated acute kidney injury/ICU hospitalization prognosis/Urinary protein分类
临床医学引用本文复制引用
张丹丹,王楠,周明锴,卢艳秋,王赛男,杜航..不同剂量右美托咪定对改善脓毒血症相关急性肾损伤患者预后的临床分析[J].西南医科大学学报,2025,48(6):650-656,7.基金项目
河南省医学科技攻关计划项目(LHGJ20220028) （LHGJ20220028）
