Faculty of Nursing, Mahidol University, Bangkok, Thailand.
Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
J Vasc Nurs. 2024 Jun;42(2):99-104. doi: 10.1016/j.jvn.2024.02.001. Epub 2024 Feb 17.
Postoperative acute kidney injury (AKI) is one of the most frequent complications in abdominal aortic aneurysm (AAA) patients after open and endovascular aortic aneurysm repair. AKI decreases the efficiency of kidney function, allowing accumulation of waste products in the body, and an imbalance of water, acid and electrolytes in the body. As a result, the functioning of various organs throughout the body is affected. These effects may raise the cost of treatment, length of stay, and mortality rate.
This study aims to examine the predictive factors of AKI - preoperative of estimated glomerular filtration rate (eGFR), preoperative of hemoglobin level, types of abdominal aortic aneurysms repair, and intraoperative of cardiac arrhythmias - after open and endovascular aortic repair among AAA patients within 72 h.
This is a retrospective study of 196 patients with AAA after elective open and endovascular aortic aneurysm repair within the first 72 h who met the inclusion criteria recruited from a tertiary care hospital in Bangkok, Thailand. Postoperative AKI after elective open and endovascular aortic repair among AAA patients is defined by the 2012 Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines.
A total of 196 AAA patients, 75.5% were male with an average age of 75.12 years (SD = 8.45). Endovascular aortic aneurysm repair was used more frequently than open aortic aneurysm repair (64.8% vs 35.2%) and 37.2% of the AAA patients had intraoperative cardiac arrhythmias. The occurrence of AKI among the AAA patients after abdominal aortic aneurysm repair within 72 h was 54.1%. The AKI rate of EVAR patients was 69.8% while the AKI rate for OAR patients was 30.2%. The preoperative estimated glomerular filtration rate (eGFR) and hemoglobin level were found to jointly predict AKI and explain 32.2% of the variance (Nagelkerke R = 0.322, p < .05). However, the type of abdominal aortic aneurysms repair and intraoperative cardiac arrhythmias did not correlate with the incidence of AKI in AAA repair patients. The predictive factors for AKI among AAA patients after aortic aneurysm repair were preoperative eGFR < 60 mL/min/1.73 m (OR = 4.436, 95% CI: 2.202-8.928, p < .001) and preoperative hemoglobin level between 8.1-10.0 g/dL (OR = 4.496, 95% CI: 1.831-11.040, p = .001).
Preoperative eGFR < 60 mL/min/1.73 m and preoperative hemoglobin level between 8.1-10.0 g/dL were the predictive factors for AKI among AAA patients after both open and endovascular AAA repair. Therefore, healthcare providers should be aware of and monitor signs of AKI after surgery in AAA patients, especially those undergoing EVAR with lower eGFR and hemoglobin levels.
术后急性肾损伤（AKI）是腹主动脉瘤（AAA）患者开放和血管内主动脉瘤修复后最常见的并发症之一。AKI 降低了肾功能效率，导致体内废物积累，并导致体内水、酸和电解质失衡。因此，全身各种器官的功能都会受到影响。这些影响可能会增加治疗费用、住院时间和死亡率。
本研究旨在探讨术前估算肾小球滤过率（eGFR）、术前血红蛋白水平、腹主动脉瘤修复类型和术中心律失常等术前因素对接受开放和血管内主动脉修复的 AAA 患者术后 72 小时内 AKI 的预测作用。
这是一项回顾性研究，纳入了 196 例在曼谷一家三级护理医院接受择期开放和血管内主动脉瘤修复后 72 小时内的 AAA 患者，这些患者符合纳入标准。根据 2012 年肾脏病改善全球结局（KDIGO）临床实践指南，定义术后择期开放和血管内主动脉修复后 AAA 患者的 AKI。
共有 196 例 AAA 患者，75.5%为男性，平均年龄为 75.12 岁（SD=8.45）。血管内主动脉瘤修复的使用频率高于开放主动脉瘤修复（64.8%比 35.2%），37.2%的 AAA 患者术中发生心律失常。在接受腹主动脉瘤修复后 72 小时内，AAA 患者 AKI 的发生率为 54.1%。EVAR 患者的 AKI 发生率为 69.8%，而 OAR 患者的 AKI 发生率为 30.2%。术前估算肾小球滤过率（eGFR）和血红蛋白水平共同预测 AKI，解释了 32.2%的方差（Nagelkerke R=0.322，p<.05）。然而，腹主动脉瘤修复类型和术中心律失常与 AAA 修复患者 AKI 的发生率无关。AAA 患者血管内修复后 AKI 的预测因素为术前 eGFR<60mL/min/1.73m（OR=4.436，95%CI：2.202-8.928，p<.001）和术前血红蛋白水平为 8.1-10.0g/dL（OR=4.496，95%CI：1.831-11.040，p=.001）。
术前 eGFR<60mL/min/1.73m 和术前血红蛋白水平在 8.1-10.0g/dL 之间是 AAA 患者开放和血管内 AAA 修复后发生 AKI 的预测因素。因此，医疗保健提供者应该意识到并监测 AAA 患者术后 AKI 的迹象，尤其是那些接受 EVAR 且 eGFR 和血红蛋白水平较低的患者。
