Tang Yongzhong, Li Bo, Ouyang Wen, Jiang Guiping, Tang Hongjia, Liu Xing
Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
Operation Center, The Third Xiangya Hospital, Central South University, Changsha 410013, China.
J Pers Med. 2023 Mar 17;13(3):541. doi: 10.3390/jpm13030541.
It is well demonstrated that intraoperative blood pressure is associated with postoperative acute kidney injury (AKI); however, the association between severity and duration of abnormal intraoperative blood pressure (BP) with AKI in patients undergoing laparoscopic surgery remains unknown.
This retrospective cohort study included 12,414 patients aged ≥ 18 years who underwent a single elective laparoscopic abdominal surgery during hospitalization between October 2011 and April 2017. Multivariate stepwise logistic regressions were applied to determine the correlation between the severity and duration of intraoperative mean arterial pressure (MAP, (systolic BP + 2 × diastolic BP)/3), acute intraoperative hypertension (IOTH) and postoperative AKI, in different periods of surgery.
A total of 482 hospitalized patients (3.9%) developed surgery-related AKI. Compared with those without IOTH or with preoperative mean MAP (80-85 mmHg), acute elevated IOTH (odds ratio, OR, 1.4, 95% CI, 1.1 to 1.7), mean MAP 95-100 mmHg (OR, 1.8; 95% CI, 1.3 to 2.7), MAP 100-105 mmHg (OR, 2.4; 95% CI, 1.6 to 3.8), and more than 105 mmHg (OR, 1.9; 95% CI, 1.1 to 3.3) were independent of other risk factors in a diverse cohort undergoing laparoscopic surgery. In addition, the risk of postoperative AKI appeared to result from long exposure (≥20 min) to IOTH (OR, 1.9; 95% CI, 1.5 to 2.5) and MAP ≥ 115 mmHg (OR, 2.2; 95% CI, 1.6 to 3.0). Intraoperative hypotension was not found to be associated with AKI in laparoscopic surgery patients.
Postoperative AKI correlates positively with intraoperative hypertension in patients undergoing laparoscopic surgery. These findings provide an intraoperative evaluation criterion to predict the occurrence of postoperative AKI.
已有充分证据表明术中血压与术后急性肾损伤（AKI）相关；然而，腹腔镜手术患者术中异常血压（BP）的严重程度和持续时间与AKI之间的关联仍不清楚。
这项回顾性队列研究纳入了2011年10月至2017年4月住院期间接受单次择期腹腔镜腹部手术的12414例年龄≥18岁的患者。应用多变量逐步逻辑回归分析，以确定不同手术阶段术中平均动脉压（MAP，（收缩压+2×舒张压）/3）、术中急性高血压（IOTH）的严重程度和持续时间与术后AKI之间的相关性。
共有482例住院患者（3.9%）发生了手术相关AKI。与无IOTH或术前平均MAP为80-85 mmHg的患者相比，急性IOTH升高（比值比，OR，1.4，95%置信区间，1.1至1.7）、平均MAP为95-100 mmHg（OR，1.8；95%置信区间，1.3至2.7）、MAP为100-105 mmHg（OR，2.4；95%置信区间1.6至3.8）以及超过105 mmHg（OR，1.9；95%置信区间，1.1至3.3）在接受腹腔镜手术的不同队列中独立于其他危险因素。此外，术后AKI的风险似乎源于长时间暴露（≥20分钟）于IOTH（OR，1.9；95%置信区间，1.5至2.5）和MAP≥115 mmHg（OR，2.2；95%置信区间，1.6至3.0）。在腹腔镜手术患者中未发现术中低血压与AKI相关。
腹腔镜手术患者术后AKI与术中高血压呈正相关。这些发现为预测术后AKI的发生提供了术中评估标准。
