BACKGROUND Paediatric acute kidney injury (AKI) is common and linked to longer hospitalisation and mortality. We investigated whether a continuous intraoperative infusion of dexmedetomidine, which increases renal blood flow, was associated with a lower risk of postoperative AKI in paediatric patients undergoing noncardiac surgery. METHODS This retrospective cohort study included paediatric patients undergoing noncardiac surgery between January 2019 and July 2021. Propensity score matching, based on the participants' baseline characteristics, was used to minimise the potential bias. The primary outcome was AKI within 7 days after surgery. The secondary outcomes included ICU admission, in-hospital mortality, length of hospitalisation, intraoperative bradycardia, and hypotension. The exposure of interest was continuous intraoperative infusion of dexmedetomidine at any dosage or duration. Multivariable logistic regression and linear regression analyses were further used to adjust for residual imbalanced intraoperative factors in the matched cohort. RESULTS After propensity score matching, we identified 1858/4091 paediatric patients who had received intraoperative dexmedetomidine infusion. Intraoperative dexmedetomidine infusion was associated with a lower risk of AKI (1.4% vs 3.2%; odds ratio 0.43, 95% confidence interval 0.27-0.66; P<0.001), postoperative ICU admission (odds ratio 0.35, 95% confidence interval 0.30-0.42; P<0.001), and shorter hospitalisation (7 [5-10] vs 9 [6-13] days; P<0.001). Intraoperative bradycardia, hypotension, and in-hospital mortality were similar between the matched groups. CONCLUSIONS This retrospective analysis of a single-centre paediatric noncardiac surgery cohort suggests that intraoperative dexmedetomidine infusion was associated with a lower incidence of AKI within 7 days after surgery. CLINICAL TRIAL REGISTRATION ChiCTR2300069115.

中文翻译：

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儿科非心脏手术中的术中右美托咪定和急性肾损伤：回顾性倾向评分匹配分析。


背景 小儿急性肾损伤 （AKI） 很常见，与住院时间和死亡率延长有关。我们研究了术中持续输注增加肾血流量的右美托咪定是否与接受非心脏手术的儿科患者术后 AKI 风险降低有关。方法 这项回顾性队列研究包括 2019 年 1 月至 2021 年 7 月期间接受非心脏手术的儿科患者。基于参与者基线特征的倾向评分匹配用于最大限度地减少潜在偏倚。主要结局是术后 7 天内的 AKI。次要结局包括 ICU 收治率、院内死亡率、住院时间、术中心动过缓和低血压。感兴趣的暴露是术中连续输注任何剂量或持续时间的右美托咪定。进一步采用多变量 logistic 回归和线性回归分析来调整匹配队列中残余的术中不平衡因素。结果 倾向评分匹配后，我们确定了 1858/4091 例术中接受右美托咪定输注的儿科患者。术中输注右美托咪定与 AKI 风险降低相关 （1.4% vs 3.2%;比值比 0.43,95% 置信区间 0.27-0.66;P<0.001），术后入住 ICU （比值比 0.35,95% 置信区间 0.30-0.42;P<0.001）和更短的住院时间（7 [5-10] vs 9 [6-13] 天;P<0.001）。匹配组之间的术中心动过缓、低血压和院内死亡率相似。 结论 这项对单中心儿科非心脏手术队列的回顾性分析表明，术中右美托咪定输注与术后 7 天内 AKI 发病率降低相关。临床试验注册 ChiCTR2300069115。