Department of Surgery, Swiss Hepatopancreatobiliary and Transplantation Center, Zurich, Switzerland.
Br J Surg. 2015 Jun;102(7):805-12. doi: 10.1002/bjs.9810. Epub 2015 Apr 15.
Epidural analgesia (EDA) is a common analgesia regimen in liver resection, and is accompanied by sympathicolysis, peripheral vasodilatation and hypotension in the context of deliberate intraoperative low central venous pressure. This associated fall in mean arterial pressure may compromise renal blood pressure autoregulation and lead to acute kidney injury (AKI). This study investigated whether EDA is a risk factor for postoperative AKI after liver surgery.
The incidence of AKI was investigated retrospectively in patients who underwent liver resection with or without EDA between 2002 and 2012. Univariable and multivariable analyses were performed including recognized preoperative and intraoperative predictors of posthepatectomy renal failure.
A series of 1153 patients was investigated. AKI occurred in 8·2 per cent of patients and was associated with increased morbidity (71 versus 47·3 per cent; P = 0·003) and mortality (21 versus 0·3 per cent; P < 0·001) rates. The incidence of AKI was significantly higher in the EDA group (10·1 versus 3·7 per cent; P = 0·003). Although there was no significant difference in the incidence of AKI between patients undergoing minor hepatectomy with or without EDA (5·2 versus 2·7 per cent; P = 0·421), a substantial difference in AKI rates occurred in patients undergoing major hepatectomy (13·8 versus 5·0 per cent; P = 0·025). In multivariable analysis, EDA remained an independent risk factor for AKI after hepatectomy (P = 0·040).
EDA may be a risk factor for postoperative AKI after major hepatectomy.
硬膜外镇痛（EDA）是肝切除术中常用的镇痛方案，在术中故意维持低中心静脉压的情况下，会伴有交感神经阻滞、外周血管扩张和低血压。这种平均动脉压的下降可能会损害肾血压自动调节，导致急性肾损伤（AKI）。本研究旨在探讨 EDA 是否是肝手术后发生术后 AKI 的危险因素。
回顾性调查了 2002 年至 2012 年间行肝切除术且有或无 EDA 的患者的 AKI 发生率。进行了单变量和多变量分析，包括肝切除术后肾功能衰竭的术前和术中公认的预测因素。
研究了一系列 1153 例患者。AKI 发生率为 8.2%，与更高的发病率（71%比 47.3%；P=0.003）和死亡率（21%比 0.3%；P<0.001）相关。EDA 组 AKI 的发生率显著更高（10.1%比 3.7%；P=0.003）。尽管行小范围肝切除术且有或无 EDA 的患者 AKI 发生率无显著差异（5.2%比 2.7%；P=0.421），但行大范围肝切除术的患者 AKI 发生率差异较大（13.8%比 5.0%；P=0.025）。多变量分析显示，肝切除术后 EDA 仍然是 AKI 的独立危险因素（P=0.040）。
EDA 可能是大范围肝切除术后术后 AKI 的危险因素。
