Yamanaka Masaya, Sugimoto Hiroyuki, Yokoyama Hiroyuki, Mochizuki Yoshinari, Taniguchi Kenji
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Surgery, Komaki City Hospital, Komaki, Japan.
Department of Surgery, Komaki City Hospital, Komaki, Japan.
Surgery. 2022 May;171(5):1406-1411. doi: 10.1016/j.surg.2021.09.002. Epub 2022 Jan 31.
Postoperative acute kidney injury after digestive surgery can be a critical problem that causes morbidity or mortality. Although serum creatinine reflects the renal function, it takes time to measure, and only severe renal failure induces an increase in creatinine. We tried to calculate the renal artery pulsatility index as a parameter to enable the real-time monitoring of acute kidney injury, which can be measured by routine bedside ultrasonography. This study aimed to evaluate the accuracy of the renal artery pulsatility index for the early detection of acute kidney injury after digestive surgery.
One hundred consecutive patients who underwent digestive surgery in a single institution from March to July 2018 were included. The renal artery pulsatility index was measured at 4 time points (preoperative day, postoperative day 1, postoperative day 4, and postoperative day 7). Perioperative acute kidney injury I was defined as a >0.3 mg/dL increase in serum creatinine and a serum creatinine level of >1.0 mg/dL at any postoperative time point. The association of the renal artery pulsatility index with perioperative acute kidney injury was analyzed.
The preoperative renal artery pulsatility index (average 1.4) was significantly high in aged patients and those with diabetes mellitus, hypertension, or chronic kidney disease. Furthermore, a high preoperative renal artery pulsatility index (cut-off: 1.6) was a predictor of perioperative acute kidney injury (n = 13). Moreover, the postoperative renal artery pulsatility index significantly increased in acute kidney injury cases.
The renal artery pulsatility index was strongly correlated with acute kidney injury in the perioperative period. It appears to be an effective and less invasive procedure for the real-time monitoring that enables the early detection of acute kidney injury after digestive surgery.
消化手术后的术后急性肾损伤可能是一个导致发病或死亡的关键问题。尽管血清肌酐反映肾功能，但测量需要时间，且只有严重肾衰竭才会导致肌酐升高。我们试图计算肾动脉搏动指数作为一个参数，以便能够通过常规床边超声测量对急性肾损伤进行实时监测。本研究旨在评估肾动脉搏动指数在消化手术后早期检测急性肾损伤的准确性。
纳入2018年3月至7月在单一机构接受消化手术的100例连续患者。在4个时间点（术前日、术后第1天、术后第4天和术后第7天）测量肾动脉搏动指数。围手术期急性肾损伤I定义为术后任何时间点血清肌酐升高>0.3mg/dL且血清肌酐水平>1.0mg/dL。分析肾动脉搏动指数与围手术期急性肾损伤的相关性。
老年患者以及患有糖尿病、高血压或慢性肾病的患者术前肾动脉搏动指数（平均1.4）显著较高。此外，术前肾动脉搏动指数较高（临界值：1.6）是围手术期急性肾损伤（n = 13）的一个预测指标。此外，急性肾损伤病例术后肾动脉搏动指数显著升高。
肾动脉搏动指数与围手术期急性肾损伤密切相关。它似乎是一种有效且侵入性较小的实时监测方法，能够在消化手术后早期检测急性肾损伤。
