非心脏手术患者术中低血压及去甲肾上腺素累积剂量与术后急性肾损伤的相关性：一项回顾性队列分析
Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery: a retrospective cohort analysis.
作者信息
Saugel Bernd, Sander Michael, Katzer Christian, Hahn Christian, Koch Christian, Leicht Dominik, Markmann Melanie, Schneck Emmanuel, Flick Moritz, Kouz Karim, Rubarth Kerstin, Balzer Felix, Habicher Marit
机构信息
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA.
Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany.
出版信息
Br J Anaesth. 2025 Jan;134(1):54-62. doi: 10.1016/j.bja.2024.11.005. Epub 2024 Dec 12.
BACKGROUND
Intraoperative hypotension is associated with acute kidney injury (AKI). Clinicians thus frequently use vasopressors, such as norepinephrine, to maintain blood pressure. However, vasopressors themselves might promote AKI. We sought to determine whether both intraoperative hypotension and cumulative intraoperative norepinephrine dose are independently associated with postoperative AKI in patients undergoing noncardiac surgery.
METHODS
This was a retrospective cohort analysis of 38 338 adult male and female patients who had noncardiac surgery. The primary outcome was AKI within the first 7 postoperative days. We performed adjusted multivariable logistic regression analysis to determine whether intraoperative hypotension (quantified as area under a mean arterial pressure [MAP] of 65 mm Hg) and cumulative intraoperative norepinephrine dose were independently associated with AKI.
RESULTS
The median (25th percentile, 75th percentile) area under a MAP of 65 mm Hg was 0.09 (0.02, 0.22) mm Hg∗day in patients with AKI and 0.05 (0.01, 0.14) mm Hg∗day in patients without AKI (P<0.001). The cumulative intraoperative norepinephrine dose was 1.92 (0.00, 13.09) μg kg in patients with AKI and 0.00 (0.00, 0.00) μg kg in patients without AKI (P<0.001). Both the area under a MAP of 65 mm Hg (odds ratio 1.55 [95% confidence interval 1.17-2.02] per mm Hg∗day; P=0.002) and the cumulative intraoperative norepinephrine dose (odds ratio 1.02 [95% confidence interval 1.01-1.02] per μg kg; P<0.001) were independently associated with AKI.
CONCLUSIONS
Both intraoperative hypotension and cumulative intraoperative norepinephrine dose were independently associated with postoperative AKI in patients undergoing noncardiac surgery. Pending results of trials testing whether these relationships are causal, it seems prudent to avoid both profound hypotension and high norepinephrine doses in adults undergoing noncardiac surgery.
背景
术中低血压与急性肾损伤（AKI）相关。因此，临床医生经常使用血管升压药，如去甲肾上腺素，来维持血压。然而，血管升压药本身可能会促进急性肾损伤。我们试图确定术中低血压和术中去甲肾上腺素累积剂量是否与接受非心脏手术患者的术后急性肾损伤独立相关。
方法
这是一项对38338例接受非心脏手术的成年男女患者进行的回顾性队列分析。主要结局是术后7天内发生急性肾损伤。我们进行了校正多变量逻辑回归分析，以确定术中低血压（以平均动脉压[MAP]为65mmHg时的曲线下面积量化）和术中去甲肾上腺素累积剂量是否与急性肾损伤独立相关。
结果
发生急性肾损伤患者的平均动脉压为65mmHg时的曲线下面积中位数（第25百分位数，第75百分位数）为0.09（0.02，0.22）mmHg·天，未发生急性肾损伤患者为0.05（0.01，0.14）mmHg·天（P<0.001）。发生急性肾损伤患者的术中去甲肾上腺素累积剂量为1.92（0.00，13.09）μg/kg，未发生急性肾损伤患者为0.00（0.00，0.00）μg/kg（P<0.001）。平均动脉压为65mmHg时的曲线下面积（每mmHg·天的比值比为1.55[95%置信区间1.17-2.02]；P=0.002）和术中去甲肾上腺素累积剂量（每μg/kg的比值比为1.02[95%置信区间1.01-1.02]；P<0.001）均与急性肾损伤独立相关。
结论
术中低血压和术中去甲肾上腺素累积剂量均与接受非心脏手术患者的术后急性肾损伤独立相关。在测试这些关系是否具有因果性的试验结果出来之前，对于接受非心脏手术的成年人，避免严重低血压和高剂量去甲肾上腺素似乎是谨慎的做法。
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