An Yongbo, Shen Kai, Ye Yingjiang
Department of Gastroenterological Surgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
Surg Today. 2018 Jun;48(6):573-583. doi: 10.1007/s00595-017-1596-5. Epub 2017 Oct 19.
Postoperative acute kidney injury in patients undergoing abdominal surgery is not rare and often results in bad outcomes for patients. The incidence of postoperative acute kidney injury is hard to evaluate reliably due to its non-unified definitions in different studies. Risk factors for acute kidney injury specific to abdominal surgery include preoperative renal insufficiency, intraabdominal hypertension, blood transfusion, bowel preparation, perioperative dehydration, contrast agent and nephrotoxic drug use. Among these, preoperative renal insufficiency is the strongest predictor of acute kidney injury. The peri-operative management of high-risk patients should include meticulous selection of fluid solutions. Balanced crystalloid solutions and albumin are generally thought to be relatively safe, while the safety of hydroxyethyl starch solutions has been controversial. The purpose of the present review is to discuss the current knowledge regarding postoperative acute kidney injury in abdominal surgical settings to help surgeons make better decisions concerning the peri-operative management.
接受腹部手术的患者术后发生急性肾损伤并不罕见，且常常给患者带来不良后果。由于不同研究中对术后急性肾损伤的定义不统一，其发病率难以可靠评估。腹部手术特有的急性肾损伤危险因素包括术前肾功能不全、腹腔内高压、输血、肠道准备、围手术期脱水、使用造影剂和肾毒性药物。其中，术前肾功能不全是急性肾损伤最强的预测因素。高危患者的围手术期管理应包括精心选择液体溶液。平衡晶体溶液和白蛋白通常被认为相对安全，而羟乙基淀粉溶液的安全性一直存在争议。本综述的目的是讨论目前关于腹部手术中术后急性肾损伤的知识，以帮助外科医生在围手术期管理方面做出更好的决策。
