Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organization of Occupational Health and Safety, Hamamatsu, Japan,
Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organization of Occupational Health and Safety, Hamamatsu, Japan.
Nephron. 2019;142(4):320-327. doi: 10.1159/000499938. Epub 2019 Apr 16.
Renal function tends to deteriorate in a hyperchloremic acidifying environment, which is reflected by a decrease in the difference between sodium and chloride.
To examine the effect of furosemide administered under hyperchloremic acidosis on intraoperative oliguria and acute kidney injury in patients with preoperatively normal renal function.
In patients undergoing abdominal or orthopedic surgeries (April 2010-November 2018), we retrospectively identified patients who preoperatively had a normal renal function but experienced intraoperative oliguria under hyperchloremic acidosis (a sodium-chloride difference < 30 mEq/L) without dehydration. We compared the perioperative urine output and the incidence of postoperative acute kidney injury between patients who intraoperatively received an initial dose of 5 mg of furosemide (the furosemide group) and patients who did not intraoperatively receive furosemide (the control group).
We identified 62 patients in the furosemide group and 48 patients in the control group. The furosemide group intraoperatively received 0.11 ± 0.06 mg/kg of furosemide (range 0.06-0.39 mg/kg). Compared to the control group, the furosemide group had greater urine output (mL/kg/h) in the operating room (1.1 ± 0.7 vs. 0.3 ± 0.1, p < 0.01) and on postoperative day 1 (1.2 ± 0.5 vs. 1.1 ± 0.4, p = 0.02). The incidence of postoperative acute kidney injury was lesser in the furosemide group than that in the control group (8.0 vs. 27.0%, p < 0.01; multivariate OR 0.18; 95% CI 0.05-0.61; p < 0.01).
In surgery patients under hyperchloremic acidosis, furosemide (0.1 mg/kg) resolved intraoperative oliguria and reduced the incidence of postoperative acute kidney injury.
在高氯性酸化环境中，肾功能往往会恶化，这表现为钠氯差值的降低。
研究呋塞米在高氯性酸中毒时对术前肾功能正常患者术中少尿和急性肾损伤的影响。
在 2010 年 4 月至 2018 年 11 月间行腹部或骨科手术的患者中，我们回顾性地确定了术前肾功能正常但在高氯性酸中毒（钠氯差<30mEq/L）下无脱水而发生术中少尿的患者。我们比较了术中接受初始剂量 5mg 呋塞米（呋塞米组）和未接受呋塞米的患者（对照组）的围手术期尿量和术后急性肾损伤的发生率。
我们在呋塞米组中确定了 62 例患者，在对照组中确定了 48 例患者。呋塞米组术中接受了 0.11±0.06mg/kg 的呋塞米（范围 0.06-0.39mg/kg）。与对照组相比，呋塞米组在手术室（1.1±0.7 vs. 0.3±0.1，p<0.01）和术后第 1 天（1.2±0.5 vs. 1.1±0.4，p=0.02）的尿量（mL/kg/h）更多。呋塞米组的术后急性肾损伤发生率低于对照组（8.0% vs. 27.0%，p<0.01；多变量 OR 0.18；95%CI 0.05-0.61；p<0.01）。
在高氯性酸中毒的手术患者中，呋塞米（0.1mg/kg）可解决术中少尿，并降低术后急性肾损伤的发生率。
