Jöbsis Jasper J, Alabbas Abdullah, Milner Ruth, Reilly Christopher, Mulpuri Kishore, Mammen Cherry
Jasper J Jöbsis, Department of Paediatrics, Tergooi Hospital, 1261 AN Blaricum, The Netherlands.
World J Nephrol. 2017 Mar 6;6(2):79-85. doi: 10.5527/wjn.v6.i2.79.
To determine acute kidney in jury (AKI) incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery.
AKI incidence in children undergoing spinal instrumentation surgery at British Columbia Children's Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identified from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis (idiopathic non-idiopathic scoliosis).
Thirty five of 208 patients met criteria for AKI with an incidence of 17% (95%CI: 12%-23%). Of all children who developed AKI, 17 (49%) developed mild AKI (AKI Stage 1), 17 (49%) developed moderate AKI (Stage 2) and 1 patient (3%) met criteria for severe AKI (Stage 3). An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively classified by fluid tertiles: 70% incidence in those that received the least amount of fluids 29% that received the most fluids (> 7.9, = 0.02). Patients who developed AKI were more frequently exposed to nephrotoxins (non steroidal anti inflammatory drugs or aminoglycosides) than control patients during their peri-operative course (60% 22%, < 0.001).
We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fluid administered peri-operatively.
确定接受脊柱内固定手术儿童的急性肾损伤（AKI）发生率及AKI的潜在危险因素。
采用急性肾损伤网络（Acute Kidney Injury Network）分类法，依据血清肌酐和尿量标准，确定2006年1月至2008年12月在不列颠哥伦比亚儿童医院接受脊柱内固定手术儿童的AKI发生率。在这一特定时间段内，所有脊柱手术后的患者均在儿科重症监护病房接受监测，并留置Foley导尿管以记录每小时尿量。从我们的数据库中识别出AKI病例。在其余队列中，我们选择了不符合AKI标准的组匹配对照。对照在性别、年龄和基础诊断（特发性/非特发性脊柱侧弯）方面进行匹配。
208例患者中有35例符合AKI标准，发生率为17%（95%可信区间：12% - 23%）。在所有发生AKI的儿童中，17例（49%）发生轻度AKI（AKI 1期），17例（49%）发生中度AKI（2期），1例（3%）符合重度AKI标准（3期）。观察到AKI发生率与术中补液量呈负相关。按液体三分位数分类观察到AKI发生率与术中补液量呈负相关：补液量最少者发生率为70%，补液量最多者（> 7.9）发生率为29%，P = 0.02。发生AKI的患者在围手术期比对照患者更频繁地接触肾毒素（非甾体类抗炎药或氨基糖苷类）（60%对22%，P < 0.001）。
我们观察到儿童脊柱内固定手术后AKI的发生率较高，这可能与肾毒素的频繁使用及围手术期补液量有关。
