接受急诊剖腹手术的穿孔性腹膜炎成年患者急性肾损伤的流行病学及长期预后
Epidemiology and Long-term Outcomes of Acute Kidney Injury in Adult Patients with Perforation Peritonitis Undergoing Emergency Laparotomy.
作者信息
Priya Pallavi, Baidya Dalim K, Anand Rahul K, Ray Bikash R, Khanna Puneet, Krishna Asuri, Maitra Souvik
机构信息
Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Indian J Crit Care Med. 2024 Sep;28(9):854-858. doi: 10.5005/jp-journals-10071-24796. Epub 2024 Aug 31.
BACKGROUND
Reported incidence of acute kidney injury (AKI) is around 5.0-7.5% of all hospitalized patients, and 40% of them are postoperative patients. Major abdominal surgeries account for 3.1-35% of cases of postoperative AKI in various series. The aim of the study was to identify the incidence and risk factors of AKI in peritonitis patients undergoing emergency laparotomy.
MATERIALS AND METHODS
Adult patients aged 18-65 years undergoing emergency laparotomy for perforation peritonitis were included in this prospective observational study. Baseline clinical and laboratory data, intraoperative details and postoperative outcome data (AKI at day 7, length of intensive care unit and hospital stay, and mortality) were recorded. Logistic regression model was constructed to predict AKI at day 7.
RESULTS
= 140 patients were included in this study and 69 patients (49.3%) developed AKI within day 7. Larger volume of crystalloid [OR (95% CI) 1.00 (1.00-1.00); = 0.012], intraoperative vasopressor use (OR 7.42 (2.41-22.83); < 0.001), intraoperative blood loss [OR 1.004(1.00-1.01); = 0.003] and the presence of chronic liver disease (CLD) [OR 22.44 (1.68-299.26); = 0.019] were risk factors for the development of AKI. Acute kidney injury patients had increased mortality at day 90 (24.6% v 1.4%; < 0.001), length of ICU stay (3 days vs 0 days, < 0.001), and length of hospital stay (11 days vs 7 days; < 0.001).
CONCLUSION
In peritonitis patients undergoing emergency laparotomy, as many as 49% of patients develop AKI within 1 week. The presence of CLD, intraoperative blood loss, and the use of crystalloids and vasopressor increase the odds of developing AKI.
HOW TO CITE THIS ARTICLE
Priya P, Baidya DK, Anand RK, Ray BR, Khanna P, Krishna A, . Epidemiology and Long-term Outcomes of Acute Kidney Injury in Adult Patients with Perforation Peritonitis Undergoing Emergency Laparotomy. Indian J Crit Care Med 2024;28(9):854-858.
背景
据报道，急性肾损伤（AKI）在所有住院患者中的发病率约为5.0 - 7.5%，其中40%为术后患者。在各类研究中， major腹部手术占术后AKI病例的3.1 - 35%。本研究的目的是确定接受急诊剖腹手术的腹膜炎患者中AKI的发病率及危险因素。
材料与方法
本前瞻性观察性研究纳入了年龄在18 - 65岁、因穿孔性腹膜炎接受急诊剖腹手术的成年患者。记录基线临床和实验室数据、术中细节及术后结局数据（第7天的AKI、重症监护病房住院时间和住院时间以及死亡率）。构建逻辑回归模型以预测第7天的AKI。
结果
本研究共纳入140例患者，69例（49.3%）在第7天内发生AKI。晶体液输入量较大[比值比（95%置信区间）1.00（1.00 - 1.00）；P = 0.012]、术中使用血管升压药（比值比7.42（2.41 - 22.83）；P < 0.001）、术中失血[比值比1.004（1.00 - 1.01）；P = 0.003]以及存在慢性肝病（CLD）[比值比22.44（1.68 - 299.26）；P = 0.019]是发生AKI的危险因素。急性肾损伤患者在第90天的死亡率增加（24.6%对1.4%；P < 0.001），重症监护病房住院时间延长（3天对0天，P < 0.001），住院时间延长（11天对7天；P < 0.001）。
结论
在接受急诊剖腹手术的腹膜炎患者中，多达49%的患者在1周内发生AKI。CLD的存在、术中失血以及晶体液和血管升压药的使用增加了发生AKI的几率。
如何引用本文
Priya P，Baidya DK，Anand RK，Ray BR, Khanna P，Krishna A，. 接受急诊剖腹手术的穿孔性腹膜炎成年患者急性肾损伤的流行病学及长期结局。《印度重症监护医学杂志》2024；28（9）：854 - 858。
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