Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea, 03080.
BMC Anesthesiol. 2022 Mar 26;22(1):82. doi: 10.1186/s12871-022-01624-6.
Acute kidney injury (AKI) is one of the most common complications in patients undergoing open abdominal aortic aneurysm (AAA) repair. Dopamine has been frequently used in these patients to prevent AKI. We aimed to clarify the relationship between intraoperative dopamine infusion and postoperative AKI in patients undergoing open AAA repair.
We analyzed 294 patients who underwent open AAA repair at a single tertiary center from 2009 to 2018, retrospectively. The primary outcome was the incidence of postoperative AKI, determined by the Kidney Disease Improving Global Outcomes definition, after open AAA repair. Secondary outcomes included survival outcome, hospital and intensive care unit length of stay, and postoperative renal replacement therapy (RRT).
Postoperative AKI occurred in 21.8% (64 out of 294 patients) The risk of postoperative AKI by intraoperative dopamine infusion was greater after adjusting for risk factors (odds ratio [OR] 2.56; 95% confidence interval [CI], 1.09-5.89; P = 0.028) and after propensity score matching (OR 3.22; 95% CI 1.12-9.24; P = 0.030). On the contrary, intraoperative norepinephrine use was not associated with postoperative AKI (use vs. no use; 19.3 vs. 22.4%; P = 0.615). Patients who used dopamine showed higher requirement for postoperative RRT (6.8 vs. 1.2%; P = 0.045) and longer hospital length of stay (18 vs. 16 days, P = 0.024).
Intraoperative dopamine infusion was associated with more frequent postoperative AKI, postoperative RRT, and longer hospital length of stay in patients undergoing AAA repair, when compared to norepinephrine. Further prospective randomized clinical trial may be necessary for this topic.
急性肾损伤（AKI）是接受开放性腹主动脉瘤（AAA）修复术患者最常见的并发症之一。多巴胺在这些患者中经常被用于预防 AKI。我们旨在阐明开放性 AAA 修复术中多巴胺输注与术后 AKI 的关系。
我们分析了 2009 年至 2018 年期间在一家单一的三级中心接受开放性 AAA 修复术的 294 例患者，进行回顾性分析。主要结局是根据肾脏病改善全球结局（KDIGO）定义，在接受开放性 AAA 修复术后发生的术后 AKI 的发生率。次要结局包括生存结局、住院和重症监护病房（ICU）的住院时间，以及术后肾脏替代治疗（RRT）。
术后 AKI 的发生率为 21.8%（294 例患者中有 64 例）。在调整了危险因素后，术中多巴胺输注发生术后 AKI 的风险更高（优势比[OR]2.56；95%置信区间[CI]1.09-5.89；P=0.028），并且在倾向评分匹配后也是如此（OR 3.22；95%CI 1.12-9.24；P=0.030）。相反，术中去甲肾上腺素的使用与术后 AKI 无关（使用与不使用；19.3%与 22.4%；P=0.615）。使用多巴胺的患者对术后 RRT 的需求更高（6.8%与 1.2%；P=0.045），并且住院时间更长（18 天与 16 天，P=0.024）。
与去甲肾上腺素相比，在接受 AAA 修复术的患者中，术中多巴胺输注与更频繁的术后 AKI、术后 RRT 和更长的住院时间相关。对于这一主题，可能需要进一步进行前瞻性随机临床试验。
