Yu Jihion, Park Hyung Keun, Kwon Hyun-Jung, Lee Joonho, Hwang Jai-Hyun, Kim Hee Yeong, Kim Young-Kug
Department of Anesthesiology and Pain Medicine Department of Urology, Asan Medical Center, University of Ulsan College of Medicine Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2018 Jul;97(30):e11580. doi: 10.1097/MD.0000000000011580.
Percutaneous nephrolithotomy (PNL) is a minimally invasive technique for renal stone removal but can cause renal parenchymal injury. Renal stones can also affect renal function. We evaluated the risk factors for acute kidney injury (AKI) after PNL.The study cohort included 662 patients who underwent PNL. Patient characteristics, preoperative laboratory values, intraoperative data, and stone characteristics were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AKI after PNL. Postoperative outcomes such as hospitalization, intensive care unit admission rate and stay duration, and chronic kidney disease were also evaluated.Of the total study series, there were 107 (16.2%) cases of AKI after PNL (AKI group), and 555 (83.8%) patients who showed no injury (no-AKI group). The risk factors for AKI after PNL were found to be a higher preoperative serum uric acid level [odds ratio (OR) = 1.228; 95% confidence interval (95% CI) = 1.065-1.415; P = .005], longer operation time (OR = 1.009; 95% CI = 1.004-1.014; P < .001), and intraoperative hypotension (OR = 12.713; 95% CI = 7.762-20.823; P < .001). Hospitalization and intensive care unit stay duration were significantly longer in the AKI group (8.7 ± 5.2 vs 6.6 ± 2.8 days, P < .001; 0.34 ± 1.74 vs 0.07 ± 0.48 days, P = .002, respectively). Chronic kidney disease was also significantly higher in the AKI group (63.6% vs 32.7%, P = .024).As intraoperative hypotension is an important risk factor for AKI after PNL, which leads to poor postoperative outcomes, it should be prevented or managed vigorously during PNL.
经皮肾镜取石术（PNL）是一种用于去除肾结石的微创技术，但可能会导致肾实质损伤。肾结石也会影响肾功能。我们评估了PNL术后急性肾损伤（AKI）的危险因素。研究队列包括662例行PNL的患者。收集了患者的特征、术前实验室检查值、术中数据和结石特征。进行单因素和多因素逻辑回归分析以确定PNL术后AKI的危险因素。还评估了术后结局，如住院时间、重症监护病房入住率和住院时长以及慢性肾脏病情况。在整个研究系列中，PNL术后有107例（16.2%）发生AKI（AKI组），555例（83.8%）患者未出现损伤（非AKI组）。发现PNL术后AKI的危险因素为术前血清尿酸水平较高[比值比（OR）=1.228；95%置信区间（95%CI）=1.065 - 1.415；P = 0.005]、手术时间较长（OR = 1.009；95%CI = 1.004 - 1.014；P < 0.001）以及术中低血压（OR = 12.713；95%CI = 7.762 - 20.823；P < 0.001）。AKI组的住院时间和重症监护病房住院时长显著更长（分别为8.7±5.2天对6.6±2.8天，P < 0.001；0.34±1.74天对0.07±0.48天，P = 0.002）。AKI组的慢性肾脏病发生率也显著更高（63.6%对32.7%，P = 0.024）。由于术中低血压是PNL术后AKI的重要危险因素，会导致不良的术后结局，因此在PNL期间应积极预防或处理。
