急性肾损伤是危重症患者非心脏手术后心肌损伤的独立危险因素。

Acute kidney injury is an independent risk factor for myocardial injury after noncardiac surgery in critical patients.

作者信息

Zhao Xiu-Juan, Zhu Feng-Xue, Li Shu, Zhang Hong-Bin, An You-Zhong

机构信息

Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.

出版信息

J Crit Care. 2017 Jun;39:225-231. doi: 10.1016/j.jcrc.2017.01.011. Epub 2017 Jan 26.

DOI:10.1016/j.jcrc.2017.01.011

PMID:28202201

Abstract

BACKGROUND

Myocardial injury after noncardiac surgery (MINS) contributes to mortality and morbidity. However, risk factors accelerating its development remain unclear. The aim of this study was to identify the incidence and risk factors of MINS.

METHODS

A retrospective and observational cohort study of critical patients (n=1087) after noncardiac surgery was carried out at a large and tertiary university hospital from January 2012 to January 2013. The clinical data including medical history as well as intraoperative and postoperative variables were recorded. The primary outcome was the occurrence of MINS. Secondary outcomes included 30-day all-cause mortality and the incidence of 30-day major adverse cardiac events (MACE) after surgery. The risk factors of MINS in critical patients were analyzed using logistic regression.

RESULTS

MINS had occurred in 188 (17.3%) of the 1087 critical patients. Fifty-seven patients (5.2%) had postoperative acute kidney injury (AKI), wherein stage 1 accounted for 82.5% (47/57), stage 2 accounted for 12.3% (7/57), and stage 3 accounted for 5.3% (3/57). The independent risk factors of MINS in critical patients were emergency surgery (odds ratio [OR], 2.64; 95% confidence interval [CI], 1.60-4.35; P<.001), a longer time of operation (OR, 1.10; 95% CI, 1.03-1.17; P=.004), postoperative AKI (OR, 2.09; 95% CI, 1.15-3.79; P=.015), vasopressor drugs used within 24 hours after operation (OR, 2.27; 95% CI, 1.40-3.67; P=.001), and a higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.05; 95% CI, 1.02-1.08; P=.002). All-cause mortality and MACE after surgery were not related to postoperative AKI (P=.544 for mortality; P=.663 for MACE).

CONCLUSIONS

The incidence of MINS in critical patients is high. Postoperative AKI is an independent risk factor of MINS in critical patients. It is recommended that postoperative kidney functions be routinely assessed in all critical patients after noncardiac surgery.

摘要

背景

非心脏手术后心肌损伤（MINS）会导致死亡率和发病率上升。然而，加速其发展的危险因素仍不明确。本研究旨在确定MINS的发生率和危险因素。

方法

2012年1月至2013年1月在一家大型三级大学医院对非心脏手术后的重症患者（n = 1087）进行了一项回顾性观察队列研究。记录了包括病史以及术中、术后变量在内的临床数据。主要结局是MINS的发生。次要结局包括30天全因死亡率和术后30天主要不良心脏事件（MACE）的发生率。使用逻辑回归分析重症患者中MINS的危险因素。

结果

1087例重症患者中有188例（17.3%）发生了MINS。57例患者（5.2%）术后发生急性肾损伤（AKI），其中1期占82.5%（47/57），2期占12.3%（7/57），3期占5.3%（3/57）。重症患者中MINS的独立危险因素为急诊手术（比值比[OR]，2.64；95%置信区间[CI]，1.60 - 4.35；P <.001）、手术时间较长（OR，1.10；95% CI，1.03 - 1.17；P =.004）、术后AKI（OR，2.09；95% CI，1.15 - 3.79；P =.015）、术后24小时内使用血管加压药物（OR，2.27；95% CI，1.40 - 3.67；P =.001）以及较高的急性生理与慢性健康状况评估II评分（OR，1.05；95% CI，1.02 - 1.08；P =.002）。术后全因死亡率和MACE与术后AKI无关（死亡率P =.544；MACE P =.663）。