Chiu Catherine, Fong Nicholas, Lazzareschi Daniel, Mavrothalassitis Orestes, Kothari Rishi, Chen Lee-Lynn, Pirracchio Romain, Kheterpal Sachin, Domino Karen B, Mathis Michael, Legrand Matthieu
Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA, USA.
Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Br J Anaesth. 2022 Sep;129(3):317-326. doi: 10.1016/j.bja.2022.05.002. Epub 2022 Jun 8.
Practice patterns related to intraoperative fluid administration and vasopressor use have potentially evolved over recent years. However, the extent of such changes and their association with perioperative outcomes, such as the development of acute kidney injury (AKI), have not been studied.
We performed a retrospective analysis of major abdominal surgeries in adults across 26 US hospitals between 2015 and 2019. The primary outcome was AKI as defined by the Kidney Disease Improving Global Outcomes definition (KDIGO) using only serum creatinine criteria. Univariable linear predictive additive models were used to describe the dose-dependent risk of AKI given fluid administration or vasopressor use.
Over the study period, we observed a decrease in the volume of crystalloid administered, a decrease in the proportion of patients receiving more than 10 ml kg h of crystalloid, an increase in the amount of norepinephrine equivalents administered, and a decreased duration of hypotension. The incidence of AKI increased between 2016 and 2019. An increase of crystalloid administration from 1 to 10 ml kg h was associated with a 58% decreased risk of AKI.
Despite decreased duration of hypotension during the study period, decreased fluid administration and increased vasopressor use were associated with increased incidence of AKI. Crystalloid administration below 10 ml kg h was associated with an increased risk of AKI. Although no causality can be concluded, these data suggest that prevention and treatment of hypotension during abdominal surgery with liberal use of vasopressors at the expense of fluid administration is associated with an increased risk of postoperative AKI.
近年来，与术中液体输注和血管升压药使用相关的实践模式可能已经发生了演变。然而，此类变化的程度及其与围手术期结局（如急性肾损伤（AKI）的发生）之间的关联尚未得到研究。
我们对2015年至2019年间美国26家医院的成人腹部大手术进行了回顾性分析。主要结局是根据改善全球肾脏病预后组织（KDIGO）定义，仅使用血清肌酐标准定义的AKI。使用单变量线性预测加法模型来描述给予液体输注或使用血管升压药时AKI的剂量依赖性风险。
在研究期间，我们观察到晶体液输注量减少，接受超过10 ml·kg·h晶体液的患者比例下降，去甲肾上腺素等效物给药量增加，低血压持续时间缩短。2016年至2019年间AKI的发生率有所增加。晶体液输注量从1 ml·kg·h增加到10 ml·kg·h与AKI风险降低58%相关。
尽管在研究期间低血压持续时间缩短，但液体输注减少和血管升压药使用增加与AKI发生率增加相关。低于10 ml·kg·h的晶体液输注与AKI风险增加相关。尽管无法得出因果关系，但这些数据表明，以减少液体输注为代价大量使用血管升压药来预防和治疗腹部手术期间的低血压与术后AKI风险增加相关。
