aAnesthesia and Intensive Care Department, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre bAnesthesia and Intensive Care Department, Hôpital d'instruction des armées Percy, Clamart, France.
Curr Opin Crit Care. 2017 Dec;23(6):447-456. doi: 10.1097/MCC.0000000000000463.
To review epidemiology and pathophysiology of acute kidney injury (AKI) in trauma patients and propose strategies that aim at preventing AKI after trauma.
AKI in trauma patients has been reported to be as frequent as 50% with an association to a prolonged length of stay and a raise in mortality. Among the specific risk factors encountered in trauma patients, hemorrhagic shock, rhabdomyolysis severity, age, and comorbidities are independently associated with AKI occurrence. Resuscitation with balanced solutes seems to have beneficial effects on renal outcome compared with NaCl 0.9%, particularly in the context of rhabdomyolysis. However, randomized clinical studies are needed to confirm this signal. Abdominal compartment syndrome (ACS) is rare but has to be diagnosed to initiate a dedicated therapy.
The high incidence of AKI in trauma patients should lead to early identification of those at risk of AKI to establish a resuscitation strategy that aims at preventing AKI.
探讨创伤患者急性肾损伤（AKI）的流行病学和病理生理学，并提出旨在预防创伤后 AKI 的策略。
创伤患者 AKI 的发生率高达 50%，与住院时间延长和死亡率升高有关。在创伤患者中遇到的具体危险因素中，失血性休克、横纹肌溶解严重程度、年龄和合并症与 AKI 的发生独立相关。与生理盐水 0.9%相比，平衡盐溶液复苏似乎对肾脏结局有有益影响，特别是在横纹肌溶解的情况下。然而，需要随机临床试验来证实这一信号。腹腔间隔室综合征（ACS）虽然罕见，但必须诊断出来，以启动专门的治疗。
创伤患者 AKI 的高发生率应促使早期识别那些有 AKI 风险的患者，以制定旨在预防 AKI 的复苏策略。
