老年患者围手术期急性肾损伤的危险因素：一项单中心回顾性研究。

Risk factors of perioperative acute kidney injury in elderly patients: a single-center retrospective study.

机构信息

Department of Anesthesiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.

Hunan Province Center for Clinical Anesthesia and Anesthesiology, Research Institute of Central South University, Changsha, China.

出版信息

Int Urol Nephrol. 2023 Feb;55(2):459-467. doi: 10.1007/s11255-022-03345-8. Epub 2022 Aug 25.

DOI:10.1007/s11255-022-03345-8

PMID:36008696

Abstract

PURPOSE

The elderly are vulnerable to perioperative acute kidney injury. The aim of this study was to determine the risk factors that associated with acute kidney injury among elderly patients.

METHODS

Clinical data of elderly patients (> 65 years) who underwent noncardiac, nonrenal surgery between Dec 1 2009 and July 1 2016 were collected for this single-centered historical cohort study. Univariate and multivariate analyses were conducted to explore the risk factors that contribute to acute kidney injury, which was defined as a serum creatinine increase >0.3 mg/dL within 48 h or 1.5 times increase in serum creatinine within 7 days after surgery.

RESULTS

7775 patients were eligible for the final analysis, among which 511 (6.57%) patients developed acute kidney injury. We observed 21 risk factors being associated with perioperative acute kidney injury, with the most important disposing factors being history of kidney disease (adjusted OR = 2.94, 95% CI 2.25-3.84), operation time > 180 min (aOR = 2.93, 95% CI 2.04-4.24), preoperative eGFR [15, 30) (aOR = 2.43, 95% CI 1.29-4.45), and protective factor being intraoperative use of sufentanil (aOR = 0.35, 95% CI 0.23-0.54).

CONCLUSION

This study determined risk factors for perioperative acute kidney injury among the elderly in the Second Xiangya Hospital and visualized the risk factors using nomogram and Excel calculator, which may provide some clues to further investigations. Overall, the prevalence of AKI among this large cohort is 6.57%.

CLINICAL TRIALS REGISTRATION

http://www.chictr.org.cn ; ChiCTR1900027007; October 28, 2019.

摘要

目的

老年人易发生围手术期急性肾损伤。本研究旨在确定与老年患者急性肾损伤相关的危险因素。

方法

本单中心回顾性队列研究纳入了 2009 年 12 月 1 日至 2016 年 7 月 1 日期间接受非心脏、非肾脏手术的老年患者（>65 岁）的临床资料。采用单因素和多因素分析方法探讨导致急性肾损伤的危险因素，急性肾损伤定义为术后 48 小时内血清肌酐升高>0.3mg/dL 或术后 7 天内血清肌酐升高 1.5 倍以上。

结果

7775 例患者符合最终分析条件，其中 511 例（6.57%）患者发生急性肾损伤。我们观察到 21 个与围手术期急性肾损伤相关的危险因素，最重要的易患因素是肾病病史（调整后 OR=2.94，95%CI 2.25-3.84）、手术时间>180 分钟（aOR=2.93，95%CI 2.04-4.24）、术前 eGFR[15,30)（aOR=2.43，95%CI 1.29-4.45），保护因素是术中使用舒芬太尼（aOR=0.35，95%CI 0.23-0.54）。