盐酸氨溴索对体外循环患儿术后肾功能的影响

Effects of ambroxol on renal function in children undergoing cardiopulmonary bypass

摘要:

目的：有研究表明盐酸氨溴索可减轻体外循环所致的肺损伤，但其对体外循环患者术后肾功能损害的作用尚不十分清楚。该研究拟探讨盐酸氨溴索对体外循环下室间隔缺损修补术患儿肾功能的影响，为临床应用提供参考。方法：选择在体外循环下择期行室间隔缺损修补术患儿40例，年龄3～8岁，心功能I或II级，随机分为对照组和盐酸氨溴索组，每组20例。盐酸氨溴索组切皮后缓慢静脉注射4.5 mg/kg盐酸氨溴索 (生理盐水稀释至10 mL)，对照组静脉输注等容量生理盐水。分别于术前、术后2 h、12 h、24 h及48 h取静脉血及新鲜尿液，检测尿中视黄醇结合蛋白(RBP)、N-乙酰-β-D-氨基葡萄糖酐酶(NAG)、β2-微球蛋白(β2-MG)水平及血清β2-MG、肌酐(Cr)、尿素氮(BUN)浓度。结果：与术前相比，两组术后2 h血清Cr、尿β2-MG，术后2 h及12 h血清β2-MG，术后2 h,12 h,24 h,48 h尿RBP，及术后2 h,12 h，24 h尿NAG水平升高（P<0.05）。氨溴索组术后2 h时血清Cr，术后2 h及12 h血清β2-MG、尿β2-MG，术后2 h,12 h,24 h,48 h尿RBP，以及术后12 h和24 h尿NAG的水平明显低于对照组（P<0.05）。结论：盐酸氨溴索可减轻体外循环所致患儿的肾损伤，其作用机制有待进一步研究。［中国当代儿科杂志，2009，11（8）：656-658］

Abstract:

OBJECTIVE: Some research has shown that ambroxol can alleviate lung injury induced by cardiopulmonary bypass (CPB). However, whether ambroxol has protective effects against CPB-induced renal injury remains unknown. This study investigated the effect of ambroxol on renal function in children undergoing CPB. METHODS: Forty children at ages of 3-8 years with cardiac function classⅠor Ⅱand weighing 12-25kg, underwent repair of ventricular septal defect (VSD) under CPB. They were randomly divided into two groups (n=20 each): control and ambroxol-treated. The children in the ambroxol-treated group received ambroxol of 4.5 mg/kg in 10 mL normal saline by intravenous injection after skin incision. The control group received 10 mL of normal saline instead. Serum concentrations of urea nitrogen (BUN), β2-microglobulin (β2-MG) and creatinine (Cr) and urinary β2-MG, retinol-binding-protein (RBP) and N-acetyl-β-D-glucosaminidase (NAG) were measured before operation, and 2, 12, 24 and 48 hrs after operation. RESULTS: Serum Cr and urinary β2-MG concentrations 2 hrs after operation, serum β2-MG concentration 2 and 12 hrs after operation, urinary RBP concentration 2, 12, 24 and 48 hrs after operation, and urinary NAG concentration 2, 12 and 24 hrs after operation in the control and the ambroxoltreated groups increased significantly as compared with their baseline values (before operation) (P<0.05). Serum Cr concentration 2 hrs after operation, serum β2-MG and urinary β2-MG concentrations 2 and 12 hrs after operation, urinary RBP concentration 2, 12, 24 and 48 hrs after operation, and urinary NAG concentration 12 and 24 hrs after operation in the ambroxol-treated group were significantly lower than those in the control group (P<0.05). CONCLUSIONS: Ambroxol administration before CPB is effective in reducing CPB-induced renal injury in children undergoing repair of VSD. Further research is required to understand the mechanism.［Chin J Contemp Pediatr, 2009, 11 (8):656-658］