Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand.
BMC Nephrol. 2018 Oct 22;19(1):289. doi: 10.1186/s12882-018-1081-4.
Laparoscopic abdominal surgery has been widely used to reduce the length of hospital stay and complications from open abdominal surgery. During the operation, the creation of pneumoperitoneum is used for better visualization of the operating field. However, the effect of pneumoperitoneum on kidney function is unknown. We aimed to identify risk factors and predictors associated with AKI development following laparoscopic abdominal surgery.
A single-center prospective cohort study of laparoscopic abdominal surgery patients between June 2012 and December 2013. Acute kidney injury (AKI) was identified by Kidney Disease Improving Global Outcome (KDIGO) criteria. Urinary neutrophil gelatinase associated lipocalin (uNGAL) was measured on the first 3 days after surgery as a surrogate marker of AKI.
Of the 64 patients, 23 (35%) developed postoperative AKI. The mean age, initial blood pressure, and initial glomerular filtration rate were not different between AKI and non-AKI groups. Inflation time and exposure index were significantly higher in the AKI group compared to non-AKI group (192.0 vs 151.1 min, p = 0.045, and 2325.9 vs 1866.1 mmHg-minutes, p = 0.035). Operation time, mean intra-abdominal pressure, duration of intraoperative hypotension, amount of blood loss and intravenous fluid were not different between groups. In multivariable analysis adjusted for age, diabetes, baseline estimated glomerular filtration rate, and type of operation (urological surgery), exposure index was significantly associated with postoperative AKI, with odds ratio (95% CI) 1.47 (1.05-2.04), p = 0.024. By combining the intraoperative parameters with clinical model the area under the receiver operating characteristic curve was 0.71 (95% CI 0.58-0.84).
AKI was a common condition in laparoscopic abdominal surgery. Exposure index has been proposed as a novel predictor of laparoscopic abdominal surgery associated AKI.
腹腔镜腹部手术已广泛用于减少住院时间和开放腹部手术的并发症。手术过程中，气腹的建立有助于更好地观察手术区域。然而，气腹对肾功能的影响尚不清楚。我们旨在确定与腹腔镜腹部手术后急性肾损伤（AKI）发展相关的风险因素和预测因素。
对 2012 年 6 月至 2013 年 12 月期间接受腹腔镜腹部手术的患者进行单中心前瞻性队列研究。采用肾脏疾病改善全球结局（KDIGO）标准确定急性肾损伤（AKI）。术后第 1 至 3 天测量尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）作为 AKI的替代标志物。
64 例患者中，23 例（35%）发生术后 AKI。AKI 组与非 AKI 组的平均年龄、初始血压和初始肾小球滤过率无差异。AKI 组的充气时间和暴露指数明显高于非 AKI 组（192.0 分钟比 151.1 分钟，p=0.045；2325.9 毫米汞柱-分钟比 1866.1 毫米汞柱-分钟，p=0.035）。手术时间、平均腹腔内压、术中低血压持续时间、出血量和静脉输液量在两组间无差异。在调整年龄、糖尿病、基线估计肾小球滤过率和手术类型（泌尿外科手术）后进行多变量分析，暴露指数与术后 AKI 显著相关，比值比（95%置信区间）为 1.47（1.05-2.04），p=0.024。将术中参数与临床模型相结合，ROC 曲线下面积为 0.71（95%置信区间 0.58-0.84）。
AKI 是腹腔镜腹部手术的常见并发症。暴露指数已被提出作为腹腔镜腹部手术相关 AKI 的新预测指标。
