Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States; Outcomes Research Consortium, Cleveland, OH, United States; Perioperative Outcomes and Informatics Collaborative, Winston-Salem, North Carolina, United States.
Perioperative Outcomes and Informatics Collaborative, Winston-Salem, North Carolina, United States; Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States.
Anaesth Crit Care Pain Med. 2023 Oct;42(5):101224. doi: 10.1016/j.accpm.2023.101224. Epub 2023 Apr 6.
The hypothesis that the exclusive use of the commonly used vasopressor phenylephrine during the intraoperative period in noncardiac surgery is associated with postoperative acute kidney injury (AKI) was tested.
A retrospective cohort analysis of 16,306 adults undergoing major noncardiac surgery who either did or did not receive phenylephrine was conducted. The primary outcome was the association of the use of phenylephrine with the risk of postoperative AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression models with all independently associated potential confounders, and an exploratory model considering only patients with no untreated minutes of hypotension (post-phenylephrine in the exposed cohort, or entire case in the unexposed cohort) were used in the analysis.
The study was conducted in a tertiary care university hospital where a total of 8,221 patients were exposed to phenylephrine, and 8,085 were not.
In unadjusted analysis, phenylephrine exposure was associated with an increased risk of AKI (OR 1.615, 95% CI [1.522-1.725], p < 0.001). In an adjusted model including several variables associated with AKI, phenylephrine remained associated with AKI (OR 1.325 [1.153-1.524]), as did post-phenylephrine exposure lengths of hypotension. Exclusion of patients with >1 min of post-phenylephrine exposure hypotension, also demonstrated that phenylephrine use was associated with AKI (OR 1.478, [1.245-1.753]).
The exclusive use of intraoperative phenylephrine is associated with an increased risk of postoperative renal injury. Anesthesiologists must consider a balanced approach to correct hypotension under anesthesia, including judicious choices for fluids, inotropic support when indicated, and an appropriate adjustment of the plane of anesthesia.
测试在非心脏手术期间术中单独使用常用升压药去氧肾上腺素与术后急性肾损伤（AKI）的相关性假说。
对 16306 名接受主要非心脏手术的成年人进行回顾性队列分析，这些患者要么接受了去氧肾上腺素治疗，要么没有接受去氧肾上腺素治疗。主要结局是使用去氧肾上腺素与 KDIGO 标准定义的术后 AKI 风险相关。使用逻辑回归模型分析所有独立相关的潜在混杂因素，并在分析中仅考虑无未治疗低血压分钟数的患者（暴露队列中的去氧肾上腺素后，或未暴露队列中的整个病例）。
本研究在一家三级护理大学医院进行，共有 8221 名患者暴露于去氧肾上腺素，8085 名患者未暴露于去氧肾上腺素。
未校正分析中，去氧肾上腺素暴露与 AKI 风险增加相关（OR 1.615，95%CI[1.522-1.725]，p<0.001）。在包含与 AKI 相关的几个变量的调整模型中，去氧肾上腺素仍然与 AKI 相关（OR 1.325[1.153-1.524]），去氧肾上腺素后低血压暴露时间也与 AKI 相关。排除去氧肾上腺素后低血压暴露时间>1 分钟的患者，也表明去氧肾上腺素的使用与 AKI 相关（OR 1.478[1.245-1.753]）。
术中单独使用去氧肾上腺素与术后肾损伤风险增加相关。麻醉医生必须考虑在麻醉下纠正低血压的平衡方法，包括在需要时明智地选择液体、正性肌力支持以及适当调整麻醉平面。
