Department of Intensive Care, Austin Hospital, Heidelberg.
Data Analytics Research and Evaluation (DARE) Center, Melbourne University and Austin Hospital.
Curr Opin Crit Care. 2018 Dec;24(6):568-574. doi: 10.1097/MCC.0000000000000560.
The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI).
AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, complex operations, bleeding, and hemodynamic instability are the most consistent procedure-related risk factors for AKI. AKI increases hospital stay, mortality, and chronic kidney disease, gradually with severity. Furthermore, delayed renal recovery negatively impacts on patients' outcomes. Cell cycle arrest biomarkers seem promising to identify high-risk patients who may benefit from the bundles recommended by the Kidney Disease: Improving Global Outcomes guidelines. Hemodynamic management using protocol-based administration of fluids and vasopressors helps reducing AKI. Recent studies have highlighted the benefit of personalizing the blood pressure target according to the patient's resting reference, and avoiding both hypovolemia and fluid overload. Preliminary research has reported encouraging renoprotective effects of angiotensin II and nitric oxide, which need to be confirmed. Moreover, urinary oxygenation monitoring appears feasible and a fair predictor of postoperative AKI.
AKI remains a frequent and severe postoperative complication. A personalizedmulticomponent approach might help reducing the risk of AKI and improving patients' outcomes.
本文综述了围手术期急性肾损伤（AKI）的主要方面的最新文献。
AKI 发生在每 10 例手术患者中的 1 例，心脏、骨科和大腹部手术是与最高风险相关的手术。总体而言，复杂的手术、出血和血流动力学不稳定是与 AKI 最一致的手术相关危险因素。AKI 增加了住院时间、死亡率和慢性肾脏病，严重程度逐渐增加。此外，肾脏恢复延迟对患者的预后产生负面影响。细胞周期停滞生物标志物似乎很有前途，可以识别可能受益于肾脏病：改善全球结果指南推荐的捆绑包的高危患者。使用基于方案的液体和血管加压素管理进行血流动力学管理有助于减少 AKI。最近的研究强调了根据患者的静息参考值个性化血压目标的益处，并避免血容量不足和液体过载。初步研究报告了血管紧张素 II 和一氧化氮的令人鼓舞的肾脏保护作用，这需要进一步证实。此外，尿氧监测似乎可行且是术后 AKI 的公平预测指标。
AKI 仍然是一种常见且严重的术后并发症。个性化的多组分方法可能有助于降低 AKI 的风险并改善患者的预后。
