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肝切除术后急性肾损伤预测的列线图:倾向评分匹配分析。

A nomogram for predicting acute kidney injury following hepatectomy: A propensity score matching analysis.

机构信息

Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.

Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.

出版信息

J Clin Anesth. 2023 Nov;90:111211. doi: 10.1016/j.jclinane.2023.111211. Epub 2023 Jul 20.

Abstract

STUDY OBJECTIVE

The low central venous pressure (LCVP) technique is a key technique in hepatectomy, but its impact on acute kidney injury (AKI) is unclear. The purpose of this study was to explore risk factors (in particular LCVP time) for AKI following hepatectomy.

DESIGN

A retrospective case-control study with propensity score matching.

SETTING

Operating room.

PATIENTS

A total of 1949 patients who underwent hepatectomy were studied.

INTERVENTIONS

The patients were grouped with or without AKI within 7 days after surgery. Univariable and multivariable analyses were performed, including recognized intraoperative predictors. The final result is represented as a nomogram.

MEASUREMENTS

Preoperative, intraoperative and postoperative data were collected. LCVP is monitored directly through a central venous catheter via the right internal jugular vein.

MAIN RESULTS

AKI occurred in 148 patients (7.59%). Surgery time, minimum SBP, furosemide administration and norepinephrine were identified as independent risk factors. The area under the curve for the receiver operating characteristic curves was 0.726 (95% CI 0.668-0.783).

CONCLUSION

Intraoperative parameters can be used to predict the probability of postoperative AKI. Although AKI increases the length of stay, it may not increase in-hospital mortality. LCVP time was not confirmed to be a risk factor for AKI.

摘要

研究目的

中心静脉压低(LCVP)技术是肝切除术的关键技术,但它对急性肾损伤(AKI)的影响尚不清楚。本研究旨在探讨肝切除术后 AKI 的危险因素(尤其是 LCVP 时间)。

设计

回顾性病例对照研究,采用倾向评分匹配。

地点

手术室。

患者

共研究了 1949 例接受肝切除术的患者。

干预措施

将术后 7 天内发生 AKI 的患者分为有或无 AKI 组。进行单变量和多变量分析,包括术中公认的预测因素。最终结果以列线图表示。

测量

收集术前、术中及术后数据。通过右颈内静脉的中心静脉导管直接监测 LCVP。

主要结果

148 例患者(7.59%)发生 AKI。手术时间、最低 SBP、呋塞米的使用和去甲肾上腺素被确定为独立危险因素。受试者工作特征曲线下面积为 0.726(95%CI 0.668-0.783)。

结论

术中参数可用于预测术后 AKI 的概率。尽管 AKI 增加了住院时间,但可能不会增加住院死亡率。LCVP 时间并未被证实是 AKI 的危险因素。

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