Nguyen Albert P, Gabriel Rodney A, Golts Eugene, Kistler Erik B, Schmidt Ulrich
Department of Anesthesiology, University of California San Diego, San Diego, CA.
Department of Anesthesiology, University of California San Diego, San Diego, CA; Department of Biomedical Informatics, University of California San Diego, San Diego, CA; Division of Cardiothoracic Surgery, University of California San Diego, San Diego, CA.
J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1361-1369. doi: 10.1053/j.jvca.2017.02.004. Epub 2017 Feb 5.
Perioperative risk factors and the clinical impact of acute kidney injury (AKI) and failure after lung transplantation are not well described. The incidences of AKI and acute renal failure (ARF), potential perioperative contributors to their development, and postdischarge healthcare needs were evaluated.
Retrospective.
University hospital.
Patients undergoing lung transplantation between January 1, 2011 and December 31, 2015.
The incidences of AKI and ARF, as defined using the Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria, were measured. Perioperative events were analyzed to identify risk factors for renal compromise. A comparison of ventilator days, intensive care unit (ICU) and hospital lengths of stay (LOS), 1-year readmissions, and emergency department visits was performed among AKI, ARF, and uninjured patients.
Ninety-seven patients underwent lung transplantation; 22 patients developed AKI and 35 patients developed ARF. Patients with ARF had significantly longer ICU LOS (12 days v 4 days, p < 0.001); ventilator days (4.5 days v 1 day, p < 0.001); and hospital LOS (22.5 days v 14 days, p < 0.001) compared with uninjured patients. Patients with AKI also had significantly longer ICU and hospital LOS. Patients with ARF had significantly more emergency department visits and hospital readmissions (2 v 1 readmissions, p = 0.002) compared with uninjured patients. A univariable analysis suggested that prolonged surgical time, intraoperative vasopressor use, and cardiopulmonary bypass use were associated with the highest increased risk for AKI. Intraoperative vasopressor use and cardiopulmonary bypass mean arterial pressure <60 mmHg were identified as independent risk factors by multivariable analysis for AKI.
The severity of AKI was associated with an increase in the use of healthcare resources after surgery and discharge. Certain risk factors appeared modifiable and may reduce the incidence of AKI and ARF.
肺移植围手术期危险因素以及急性肾损伤（AKI）和肾衰竭的临床影响尚未得到充分描述。对AKI和急性肾衰竭（ARF）的发生率、其发生的潜在围手术期因素以及出院后的医疗需求进行评估。
回顾性研究。
大学医院。
2011年1月1日至2015年12月31日期间接受肺移植的患者。
测量使用风险、损伤、衰竭、丧失、终末期肾病标准定义的AKI和ARF的发生率。分析围手术期事件以确定肾功能损害的危险因素。对AKI、ARF和未受损伤患者的呼吸机使用天数、重症监护病房（ICU）和住院时间（LOS）、1年再入院率和急诊就诊次数进行比较。
97例患者接受了肺移植；22例患者发生AKI，35例患者发生ARF。与未受损伤患者相比，ARF患者的ICU住院时间显著更长（12天对4天，p<0.001）；呼吸机使用天数（4.5天对1天，p<0.001）；以及住院时间（22.5天对14天，p<0.001）。AKI患者的ICU和住院时间也显著更长。与未受损伤患者相比，ARF患者的急诊就诊次数和住院再入院率显著更多（2次对1次再入院，p = 0.002）。单变量分析表明，手术时间延长、术中使用血管升压药和使用体外循环与AKI风险增加最高相关。多变量分析确定术中使用血管升压药和体外循环平均动脉压<60 mmHg为AKI的独立危险因素。
AKI的严重程度与术后及出院后医疗资源使用增加相关。某些危险因素似乎是可改变的，可能会降低AKI和ARF的发生率。
