Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France.
Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
Clin Res Hepatol Gastroenterol. 2022 Aug-Sep;46(7):101899. doi: 10.1016/j.clinre.2022.101899. Epub 2022 Mar 5.
Postoperative acute kidney injury (AKI) is a common complication in hepatic surgery. In hepatic surgery, relative hypovolemia may help to limit blood loss, but the consequences of restrictive fluid intake are unknown. The goal of this study was to determine the influence of intraoperative fluid intake on the incidence of AKI and its consequences.
Data from 397 consecutive patients who underwent liver resection were prospectively recorded and retrospectively analyszed. We compared the incidence of postoperative acute kidney failure in patients given restrictive (≤ 5 mL/kg/h) versus liberal (> 5 mL/kg/h) fluid therapy. We calculated a 1:1 match propensity score using logistic regression to estimate the likelihood of patients receiving restrictive or liberal intraoperative fluid intakes. The association between the intraoperative fluid intake strategy and occurrence of postoperative AKI were tested using a Cox frailty model on the database of matched patients.
Postoperative AKI was diagnosed in 133 of the 397 patients. Fluid intake strategy was restrictive for 121 patients and liberal for 276 patients. After propensity score matching to balance confounding factors, the liberal strategy was associated with a significantly lower risk for postoperative AKI compared to the restrictive strategy (Hazard Ratio 0.40 [0.29; 0.56], P<0.001). Patients with postoperative AKI had longer hospital stays and higher mortality. There were no cases of further blood loss in the liberal fluid intake group.
A restrictive fluid intake strategy is a risk factor for developing postoperative AKI, with serious consequences, without reducing blood loss in liver surgery.
术后急性肾损伤（AKI）是肝外科的常见并发症。在肝外科手术中，相对血容量不足可能有助于限制出血量，但限制液体摄入的后果尚不清楚。本研究的目的是确定术中液体摄入对 AKI 发生率及其后果的影响。
前瞻性记录并回顾性分析了 397 例连续行肝切除术患者的数据。我们比较了给予限制（≤5ml/kg/h）与宽松（>5ml/kg/h）液体治疗的患者术后急性肾衰的发生率。我们使用逻辑回归计算了 1:1 匹配倾向评分，以估计患者接受限制或宽松术中液体摄入的可能性。使用 Cox 脆弱模型对匹配患者的数据库测试术中液体摄入策略与术后 AKI 发生之间的关联。
397 例患者中 133 例诊断为术后 AKI。121 例患者采用限制策略，276 例患者采用宽松策略。在进行倾向评分匹配以平衡混杂因素后，与限制策略相比，宽松策略与术后 AKI 的风险显著降低（风险比 0.40 [0.29;0.56]，P<0.001）。发生术后 AKI 的患者住院时间更长，死亡率更高。在宽松液体摄入组中没有进一步失血的病例。
限制液体摄入策略是术后 AKI 的危险因素，可导致严重后果，而不会减少肝外科手术中的出血量。
