Tomozawa Arisa, Ishikawa Seiji, Shiota Nobuhiro, Cholvisudhi Phantila, Makita Koshi
Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Can J Anaesth. 2015 Jul;62(7):753-61. doi: 10.1007/s12630-015-0397-9. Epub 2015 Apr 30.
This study aimed to identify the incidence and risk factors for acute kidney injury (AKI) after liver resection surgery and to clarify the relationship between postoperative AKI and outcome.
We conducted a historical cohort study of patients who underwent liver resection surgery with sevoflurane anesthesia from January 2004 to October 2011. Acute kidney injury was diagnosed based on the Acute Kidney Injury Network classification within 72 hr after the surgery. Patient data, surgical and anesthetic data, and laboratory data were extracted manually from the patients' electronic charts. Multivariable logistic regression analysis was used to identify perioperative risk factors for postoperative AKI.
Acute kidney injury was diagnosed in 78 of 642 patients (12.1%; 95% confidence interval [CI]: 9.7 to 14.9). Multivariable analysis showed an independent association between postoperative AKI and preoperative estimated glomerular filtration rate (adjusted odds ratio [aOR] 0.74; 95% CI: 0.64 to 0.85), preoperative hypertension (aOR 2.10; 95% CI: 1.11 to 3.97), and intraoperative red blood cell transfusion (aOR 1.04; 95% CI: 1.01 to 1.07). Development of AKI within 72 hr after liver resection surgery was associated with increased hospital mortality, prolonged length of stay, and increased rates of mechanical ventilation, reintubation, and renal replacement therapy.
Perioperative risk factors for AKI after liver resection surgery are similar to those established for other surgical procedures. Further studies are needed to establish causality and to determine whether interventions on modifiable risk factors can reduce the incidence of postoperative AKI and improve patient outcome. This study was registered at the University Hospital Medical Information Network (UMIN) Center (UMIN 000008089).
本研究旨在确定肝切除术后急性肾损伤（AKI）的发生率和危险因素，并阐明术后AKI与预后的关系。
我们对2004年1月至2011年10月期间接受七氟醚麻醉下肝切除手术的患者进行了一项历史性队列研究。根据急性肾损伤网络分类标准，在术后72小时内诊断急性肾损伤。从患者电子病历中手动提取患者数据、手术和麻醉数据以及实验室数据。采用多变量逻辑回归分析确定术后AKI的围手术期危险因素。
642例患者中有78例被诊断为急性肾损伤（12.1%；95%置信区间[CI]：9.7至14.9）。多变量分析显示，术后AKI与术前估计肾小球滤过率（调整优势比[aOR]0.74；95%CI：0.64至0.85）、术前高血压（aOR 2.10；95%CI：1.11至3.97）和术中红细胞输注（aOR 1.04；95%CI：1.01至1.07）独立相关。肝切除术后72小时内发生AKI与医院死亡率增加、住院时间延长以及机械通气、再次插管和肾脏替代治疗率增加有关。
肝切除术后AKI的围手术期危险因素与其他手术所确定的危险因素相似。需要进一步研究以确定因果关系，并确定对可改变危险因素的干预是否能降低术后AKI的发生率并改善患者预后。本研究在大学医院医学信息网络（UMIN）中心注册（UMIN 000008089）。
