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Renale Effekte von Clonidin bei kardiochirurgischen Patienten

Renal effects of clonidine on cardiosurgery patients

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Clinical Research in Cardiology Supplements Aims and scope

Summary

Renal function is responsible for homoestasis in the organism. Renal impairment causes life-threatening damage. Intraoperative bleeding, hypotension, stress and toxins (endogenous, exogenous) during surgery could impair renal function and cause postoperative renal damage. Mortality after coronary graft surgery is usually between 1–2% and acute postoperative renal failure (ARF) increases mortality up to 60–75%. High sympathetic tone and extracorporal circulation under coronary graft surgery are important factors influencing postoperative renal failure. Experimental and clinical studies have shown a reduction of sympathetic tone and catecholamine concentration by α2-agonists. Renal perfusion and glomerular filtration is improved. This could prevent renal damage in patients undergoing coronary graft surgery and extracorporal circulation.

Zusammenfassung

Die Nierenfunktion ist verantwortlich für die Homöostase im Organismus, Einschränkungen können lebenswichtige Funktionen beeinträchtigen. Im Rahmen operativer Eingriffe beeinflussen verschiedene Faktoren die Nierenfunktion (Hypotonie, Blutung, endogene und exogene Toxine, Stress) und können eine postoperative Nierenfunktionseinschränkung verursachen. Das akute postoperative Nierenversagen (ANV) beeinflusst auch bei kardiochirurgischen Patienten entscheidend die Mortalität, die normalerweise bei 1–2% liegt und durch das ANV bis auf 60–75% ansteigen kann. Der erhöhte Sympathikotonus unter operativen Bedingungen und die speziell bei kardiochirurgischen Eingriffen notwendige extrakorporale Zirkulation werden als entscheidende Ursachen für die postoperative Nierenfunktionseinschränkung angesehen. In experimentellen und klinischen Studien wurde nachgewiesen, dass α2-Adrenozeptoragonisten den Sympathikotonus senken und Plasmakatecholaminspiegel vermindern. Dieses führt an der Niere zu einer verbesserten renalen Perfusion und glomerulären Filtration. Bei Patienten unter koronarer Bypasschirurgie mit extrakorporaler Zirkulation kann dadurch eine Verschlechterung der Nierenfunktion verhindert werden.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Kassel, Mönchebergstr. 41–43, 34125, Kassel, Germany

    P. Wegermann &  M. Tryba

  2. Klinik für Anästhesiologie und operative Intensivmedizin, Prosper-Hospital Recklinghausen, Mühlenstr. 27, 45659, Recklinghausen, Germany

    P. J. Kulka

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  1. P. Wegermann
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  2. M. Tryba
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  3. P. J. Kulka
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Correspondence to P. Wegermann.

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Wegermann, P., Tryba, M. & Kulka, P.J. Renale Effekte von Clonidin bei kardiochirurgischen Patienten. Clin Res Cardiol Suppl 2 (Suppl 1), S85–S90 (2007). https://doi.org/10.1007/s11789-006-0044-7

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  • DOI: https://doi.org/10.1007/s11789-006-0044-7

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