Department of Anesthesiology, Hospital de São João, Porto, Portugal.
Nefrologia. 2009;29(5):404-14. doi: 10.3265/Nefrologia.2009.29.5.5456.en.full.
In postoperative critically-ill patients who develop Acute Kidney Injury (AKI) it is important to focus on survival and quality of life beyond hospital discharge. The aim of the study was to evaluate outcome and quality of life in patients that develop AKI after major surgery.
This retrospective study was carried out in a Post-Anaesthesia Care Unit with five intensive care beds during 2 years. Patients were followed for the development of AKI. Preoperative characteristics, intra-operative management and outcome were evaluated. Six months after discharge, these patients were contacted to complete a Short Form-36 questionnaire (SF-36) and to have their dependency in ADL evaluated. Chi-square or Fischer's exact test were used to compare proportions between groups. A "t test" and a paired "t test" for independent groups was used for comparisons.
Of 1584 patients admitted to the PACU, 1200 patients met the inclusion criteria. One hundred-fourteen patients (9.6%) met AKI criteria. Patients with AKI were more severely ill, stayed longer at the PACU. Among 71 hospital survivors at 6 months follow-up, 50 completed the questionnaires. Fifty-two percent of patients reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients that met AKI criteria after surgery had worse SF-36 scores for physical function, role physical and role emotional domains. Six months after PACU discharge, patients that met AKI criteria were more dependent in I-ADL but not in P-ADL.
Patients that develop AKI improved self-perception of quality of life despite having high rate of dependency in ADL tasks. For physical function and role physical domains they had worse scores than PACU patients that did not develop AKI.
术后危重症患者发生急性肾损伤（AKI）时，重要的是要关注出院后的生存和生活质量。本研究旨在评估发生大手术后 AKI 的患者的结局和生活质量。
这项回顾性研究在 2 年内于设有 5 张重症监护床位的麻醉后恢复室（PACU）进行。患者在出院后随访发生 AKI 的情况。评估了术前特征、术中管理和结局。出院后 6 个月，联系这些患者完成简明健康调查问卷 36 项（SF-36）并评估他们日常生活活动（ADL）的依赖程度。使用卡方检验或 Fisher 确切检验比较组间的比例。使用独立样本 t 检验和配对 t 检验进行比较。
在 PACU 收治的 1584 名患者中，1200 名患者符合纳入标准。114 名患者（9.6%）符合 AKI 标准。发生 AKI 的患者病情更严重，在 PACU 停留时间更长。在 71 名出院后存活至 6 个月随访的患者中，有 50 名完成了问卷调查。52%的患者报告说，他们在回答问卷当天的总体健康状况比 12 个月前更好。手术后符合 AKI 标准的患者在生理功能、生理角色和情绪角色领域的 SF-36 评分较差。PACU 出院后 6 个月，符合 AKI 标准的患者在 I-ADL 方面依赖性更高，但在 P-ADL 方面则没有。
尽管在 ADL 任务中依赖程度较高，但发生 AKI 的患者改善了对生活质量的自我感知。在生理功能和生理角色领域，他们的评分比未发生 AKI 的 PACU 患者差。
