围手术期因素与部分肾切除术后急性肾损伤的关系。

Perioperative factors associated with acute kidney injury after partial nephrectomy.

机构信息

Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, USA.

Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Br J Anaesth. 2016 Jan;116(1):70-6. doi: 10.1093/bja/aev416.

DOI:10.1093/bja/aev416

PMID:26675951

Abstract

BACKGROUND

Partial nephrectomy is performed with the aim to preserve renal function. But the occurrence of postoperative acute kidney injury (AKI) can interfere with this goal. Our primary aim was to evaluate associations between pre-specified modifiable factors and estimated glomerular filtration rate after partial nephrectomy. Our secondary aims were to evaluate associations between pre-specified modifiable factors and both serum creatinine concentration and type of nephrectomy.

METHODS

The records of 1955 patients who underwent partial nephrectomy were collected. Postoperative estimated glomerular filtration rate (eGFR) was used as the primary outcome measure. Twenty modifiable risk factors were studied. A repeated-measures linear model with autoregressive within-subject correlation structure was used. The interaction between all the factors and type of nephrectomy was also studied.

RESULTS

A total of 1187 (61%) patients had no kidney injury, 647 (33%) had stage I, 80 (4%) had stage II, and 41 (2%) had stage III injury. The mean eGFR increased an estimated 0.83 (99.76% CI 0.79-0.88) ml min(-1) 1.73 m(-2) for a unit increase in baseline eGFR. Mean eGFR was 2.65 (99.76% CI: 0.13, 5.18) ml min(-1) 1.73 m(-2) lower in patients with hypertension. Mean eGFR decreased 0.42 (99.76% CI: 0.22, 0.62) ml min(-1) 1.73 m(-2) for a 10-minute longer in duration of procedure and decreased 2.09 (99.76% CI: 1.39, 2.80) ml min(-1) 1.73 m(-2) for a 10-minute longer in ischemia time. It was 3.53 (99.76% CI: 0.83, 6.23) ml min(-1) 1.73 m(-2) lower for patients who received warm ischemia as compared to cold ischemia.

CONCLUSION

Potentially modifiable factors associated with AKI in the postoperative period were identified as baseline renal function, preoperative hypertension, longer duration of surgical time and ischaemia time, and warm ischaemia.

摘要

背景

部分肾切除术的目的是保留肾功能。但术后急性肾损伤（AKI）的发生可能会干扰这一目标。我们的主要目的是评估术前可改变因素与部分肾切除术后估算肾小球滤过率之间的关系。我们的次要目的是评估术前可改变因素与血清肌酐浓度和肾切除术类型之间的关系。

方法

收集了 1955 例接受部分肾切除术的患者的记录。术后估算肾小球滤过率（eGFR）作为主要观察指标。研究了 20 个可改变的危险因素。采用具有自相关结构的重复测量线性模型。还研究了所有因素与肾切除术类型之间的相互作用。

结果

共有 1187 例（61%）患者无肾损伤，647 例（33%）患者为 I 期，80 例（4%）患者为 II 期，41 例（2%）患者为 III 期损伤。基线 eGFR 每增加 1 单位，eGFR 估计增加 0.83（99.76%CI 0.79-0.88）ml/min/1.73m²。高血压患者的平均 eGFR 低 2.65（99.76%CI：0.13，5.18）ml/min/1.73m²。手术时间每延长 10 分钟，eGFR 平均降低 0.42（99.76%CI：0.22，0.62）ml/min/1.73m²；缺血时间每延长 10 分钟，eGFR 平均降低 2.09（99.76%CI：1.39，2.80）ml/min/1.73m²。与冷缺血相比，热缺血患者的 eGFR 低 3.53（99.76%CI：0.83，6.23）ml/min/1.73m²。