Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
Department of Urology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
J Clin Anesth. 2020 Nov;66:109906. doi: 10.1016/j.jclinane.2020.109906. Epub 2020 Jun 29.
To assess the risk for postoperative acute kidney injury (AKI) after major urologic surgery for different intraoperative hypotension thresholds in form of time below a fixed threshold. We hypothesize that the duration of hypotension below a certain hypotension threshold is a risk factor for AKI also in major urologic procedures.
Retrospective observational cohort series.
Single tertiary high caseload center.
416 consecutive patients undergoing open radical cystectomy, pelvic lymph node dissection and urinary diversion between 2013 and 2019.
None.
We analyzed intraoperative data and their correlation to postoperative AKI judged according to the Acute Kidney Injury Network criteria. Patients were divided into groups falling below MAP <65 mmHg, MAP <60 mmHg and MAP <55 mmHg. The probability of developing postoperative AKI using all risk variables as well as the hypotension threshold variables (minutes under a certain threshold) was calculated using logistic regression methods.
Postoperative AKI was diagnosed in 128/416 patients (30.8%). Multiple logistic regression analysis showed that minutes below a threshold of 65 mmHg (OR 1.010 [1.005-1.015], P < 0.001) and 60 mmHg (OR 1.012 [1.001-1.023], P = 0.02) are associated with an increased risk of AKI. On average, 26.5% (MAP <65 mmHg), 50.0% (MAP <60 mmHg) and 76.5% (MAP <55 mmHg) of minutes below a certain threshold occurred between induction of anesthesia and start of surgery and are thus fully attributable to anesthesiological management.
Our results suggest that avoiding intraoperative MAP lower than 65 mmHg and especially lower than 60 mmHg will protect postoperative renal function in cystectomy patients. The time between induction of anesthesia and surgical incision warrants special attention as a relevant share of hypotension occur in this period.
评估不同术中低血压阈值下（以固定阈值以下的时间表示），主要泌尿外科手术后发生术后急性肾损伤（AKI）的风险。我们假设，在某些低血压阈值以下的低血压持续时间也是主要泌尿外科手术中 AKI 的一个危险因素。
回顾性观察队列研究。
单一的三级高病例量中心。
2013 年至 2019 年间连续 416 例接受开放根治性膀胱切除术、盆腔淋巴结清扫术和尿流改道术的患者。
无。
我们分析了术中数据及其与术后 AKI 的相关性，术后 AKI 是根据急性肾损伤网络标准判断的。患者分为 MAP＜65mmHg、MAP＜60mmHg 和 MAP＜55mmHg 三组。使用逻辑回归方法计算发生术后 AKI 的概率以及所有风险变量和低血压阈值变量（在某一阈值下的时间）。
416 例患者中术后 AKI 诊断为 128 例（30.8%）。多因素逻辑回归分析显示，低于 65mmHg（OR 1.010[1.005-1.015]，P＜0.001）和 60mmHg（OR 1.012[1.001-1.023]，P=0.02）的阈值时间与 AKI 风险增加相关。平均而言，26.5%（MAP＜65mmHg）、50.0%（MAP＜60mmHg）和 76.5%（MAP＜55mmHg）的阈值时间发生在麻醉诱导和手术开始之间，完全归因于麻醉管理。
我们的结果表明，避免术中 MAP 低于 65mmHg，尤其是低于 60mmHg，将保护膀胱切除术患者的术后肾功能。麻醉诱导和手术切口之间的时间需要特别注意，因为在此期间发生低血压的相关比例较高。
