食管癌术后发生急性肾损伤危险因素分析及处理  

The risk factors of acute kidney injury and perioperative management after esophagus cancer surgery

作　　者：马胡赛[1,2] 蔡奕欣[1] 张霓[1] 付向宁[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院胸外科,武汉430330 [2]青海红十字医院胸外科,西宁810000

出　　处：《临床肾脏病杂志》2015年第2期94-97,共4页Journal Of Clinical Nephrology

摘　　要：目的探讨食管癌术后急性肾损伤（acute kidneyi inury，AKI）的危险因素、临床意义及围手术期处理。方法回顾性分析397例食管癌手术患者的临床资料，统计术后AKI的发生情况，按有无AKI发生分为AKI组和非AKI组，将发生AKI患者与非AKI患者进行相关因素比较分析。结果本组研究397例食管癌手术患者中25例发生AKI，其中Ⅰ期15例，Ⅱ期4例，Ⅲ期6例，总患病率为6．3％。25例发生AKI的患者中，出院时存活21例（占84％），死亡4例（占16％）。AKI与非AKI的相关因素比较：年龄、冠心病、慢性阻塞性肺疾病、术前血肌酐、术前化疗、淋巴结清扫数、术中失血量、手术时间、术后呼吸机应用时间等因素差异，无统计学意义（P〉0．05）；糖尿病、高血压、术后肺部感染及肾外器官衰竭差异有统计学意义（P〈0．05）。Logistic多因素回归分析结果显示，糖尿病、高血压、术后肺部感染及肾外器官衰竭是食管癌术后并发AKI的独立危险因素。结论AKI是食管癌患者术后常见的并发症且易被忽视，须注意引起AKI的常见原因，对于存在AKI危险因素的患者加强围手术期管理，严密监测肾功能。一旦发生AKI，预后极差，因此，要早期选择最佳的治疗方案，提高食管癌患者术后生存率，减少病死率。Objective To explore the risk factors and clinical significance of acute kidney injury （AKI）, and perioperative management after resection of esophageal carcinoma. Methods A retrospective analysis was performed on 397 cases of AKI after esophageal cancer operation, and AKl-related factors were analyzed. Results In 397 cases undergoing esophageal cancer surgery, AKI occurred 25 cases, including 15 cases of stage I, 4 cases of stage II, and 6 cases of stage III, with the total prevalence rate being 6. 3%. Twenty-one cases were discharged from the hospital （84%）, and there were 4 deaths （16 % ）. Comparison of related factors of AKI and non-AKI： There was no significant difference in age, coronary heart disease, chronic obstructive pulmonary disease, preoperative SCr, preoperative chemotherapy, number of removed lymph nodes, intraoperative blood loss, operation time and postoperative ventilator time between AKI and non-AKI （P〉0. 05）. There were significant differences in hypertension, diabetes mellitus, postoperative lung infection and non-kidney organ failure between AKI and non-AKI （P〈C0.05）. Logistic multivariate regression analysis showed hypertension, diabetes mellitus, postoperative lung infection and non-kidney organ failure were independent risk factors associated with AKI after resection of esophageal carcinoma. Conclusions AKI is common complications and easy to be ignored after resection of esophageal carcinoma. Attention should be paid to the common causes of AKI, and the perioperative management should be strengthened for the presence of AKI risk factors.

关 键 词：急性肾损伤 食管癌 根治手术 围手术期 

分 类 号：R735.1[医药卫生—肿瘤] R692[医药卫生—临床医学]