Department of Critical Care, King's College London, Guy's and St Thomas' Hospital, London, UK.
Department of Critical Care, Guy's and St Thomas' Hospital, London, UK.
Anaesthesia. 2020 Jan;75 Suppl 1:e121-e133. doi: 10.1111/anae.14932.
The epidemiology of peri-operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri-operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri-operative acute kidney injury is associated with an increased risk of short- and long-term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury.
围手术期急性肾损伤的流行病学因定义、手术类型以及急性和慢性合并症而异。血流动力学不稳定、微循环紊乱、内皮功能障碍、炎症和肾小管细胞损伤是导致发病机制的主要因素。目前尚无特异性治疗方法。围手术期保护肾功能最有效的策略是：避免肾毒性损伤；优化血流动力学；预防低血压；以及精细的液体管理，包括避免低血容量和高血容量。围手术期急性肾损伤与短期和长期术后并发症的风险增加相关，包括住院时间延长、早期慢性肾脏病的发展以及死亡率增加。资源利用和医疗保健成本也更高。未来，先进的临床预测评分的开发、新的成像和监测技术以及急性肾损伤新生物标志物的应用有望更早地识别急性肾损伤，并采用更个性化的管理方法，以降低急性肾损伤的全球负担。
