术前血清肌酐水平对肝切除术后短期结局的影响。
The impact of pre-operative serum creatinine on short-term outcomes after liver resection.
机构信息
Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Foundation Trust Basingstoke, Hampshire, UK.
出版信息
HPB (Oxford). 2009 Dec;11(8):622-8. doi: 10.1111/j.1477-2574.2009.00094.x.
BACKGROUND
The aim of the present study was to determine whether raised pre-operative serum creatinine increased the risk of renal failure after liver resection.
METHOD
Data were studied from 1535 consecutive liver resections. Outcomes in patients with pre-operative creatinine </=124 micromol/l (Group 1) were compared with those with pre-operative creatinine >/=125 micromol/l (Group 2).
RESULTS
The median age of the 1446 (94.3%) patients resected in Group 1 was 62 years compared with 67 years in the 88 (5.7%) patients in Group 2 (P < 0.0001). Similarly this latter group had double the number of patients who were American Society of Anesthesiologists (ASA) III or IV (34.1% vs. 15.2%, P= 0.00004). Overall, the incidence of post-operative renal failure requiring haemofiltration was low (0.9%) but significantly more in Group 2 patients (5.7% vs. 0.6, P= 0.0007). In addition, patients in Group 2 were more likely to suffer acute kidney injury post-operatively (18.2% vs. 4.3%, P < 0.0001). Patients with acute kidney injury had significantly higher blood loss. Although there was no difference in mortality, patients in Group 2 had higher post-operative morbidity (37.5%) than Group 1 (21.7%, P= 0.0006), with the incidence of cardiorespiratory complications being higher in Group 2 (25.9% vs. 8.9%, P= 0.0025).
CONCLUSIONS
After liver resection, renal failure is rare but patients with an elevated creatinine pre-operatively are at an increased risk of both renal and non-renal complications.
背景
本研究旨在确定术前血清肌酐升高是否会增加肝切除术后肾功能衰竭的风险。
方法
对 1535 例连续肝切除术患者的数据进行研究。比较术前肌酐 <=124μmol/L（第 1 组）和术前肌酐 >=125μmol/L（第 2 组）患者的结局。
结果
第 1 组 1446 例（94.3%）患者的中位年龄为 62 岁，而第 2 组 88 例（5.7%）患者的中位年龄为 67 岁（P < 0.0001）。同样，后一组患者中美国麻醉师协会（ASA）III 或 IV 级的患者人数是前者的两倍（34.1%比 15.2%，P = 0.00004）。总体而言，术后需要血液滤过的肾功能衰竭发生率较低（0.9%），但第 2 组患者明显更高（5.7%比 0.6%，P = 0.0007）。此外，第 2 组患者术后发生急性肾损伤的可能性更大（18.2%比 4.3%，P < 0.0001）。发生急性肾损伤的患者失血明显更多。尽管死亡率无差异，但第 2 组患者的术后发病率（37.5%比 1 组（21.7%，P = 0.0006））高于第 1 组，第 2 组患者的心肺并发症发生率更高（25.9%比 8.9%，P = 0.0025）。
结论
肝切除术后肾功能衰竭罕见，但术前肌酐升高的患者发生肾和非肾并发症的风险增加。
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