Effects Of Dexmedetomidine On Oxidative Stress,Inflammation And Acute Kidney Injury In Elderly Patients During Laparoscopic Radical Nephrectomy

Objective:To investigate the effects of dexmedetomidine(DEX)on oxidative stress,inflammation and acute kidney injury(AKI)during laparoscopic radical nephrectomy(LRN)in elderly patients.Methods:Ninety RCC patients who received LRN from the Third Medical Center of PLA General Hospital from January 2022 to August 2022 were selected as subjects.According to random data table method,patients were divided into dexmedetomidine group(group D)and control group(group C),with 45 cases in each group.Group D was given a load dose of DEX0.6 μg/kg by intravenous pump 15 min before anesthesia induction,and then continued to be pumped 0.4μg/kg/h until half an hour before surgery.Group C was continuously pumped the same dose of sodium chloride injection by intravenous pump.MAP and HR,intraoperative extubation time,blood loss,urine volume and use of vasoactive drugs,duration of operation,length of hospital stay,intraoperative extubation time,immediately after endotracheal intubation(T1),immediately after pneumoperitoneum opening(T2),immediately after extubation(T3),and before extubation(T4)were observed in two groups.T0 and postoperative 48h(T6)serum creatinine(s Cr),estimated glomerular filtration rate(e GFR),Urea(Urea),cystatin C(Cys C),β2 microglobulin(β2-MG),C-reactive protein(CRP).According to the diagnostic criteria of KDIGO guidelines,postoperative AKI and its staging were diagnosed.Nuclear factor E2-related factor 2(Nrf2),interleukin 6(IL-6),glutathione(GSH),adanced oxidation protein products(AOPP),superoxide dismutase(SOD),malondialdehyde(MDA),and total antioxidant capacity(T-AOC)were detected in T0,T4,24 h after surgery(T5).Results:There were no significant differences in postoperative extubation time,hospital stay,incidence and grade of AKI between the two groups(P>0.05);The use of vasoactive drugs(ephedrine and norepinephrine)in group D was higher than that in group C,and the difference was statistically significant(P<0.05);At T3 and T4,HR in group D was significantly slower than that in group C,and the difference was statistically significant(P<0.05);Nrf2,MDA and AOPP levels of T4 and T5 in group D were lower than those in group C(P<0.05),the levels of GSH,SOD and T-AOC were higher than those of group C,and the differences were statistically significant(P<0.05);IL-6 levels of T4 and T5 in group D were lower than those in group C at all time points,and the differences were statistically significant(P<0.05);There were no significant differences in s Cr,e GFR,Cys C,β2-MG and CRP levels between the two groups at T0 and T6(P>0.05).Conclusion:DEX can reduce the oxidative stress injury and inflammatory reaction in the perioperative period of elderly LRN,but can not reduce the incidence of postoperative AKI.