结直肠恶性肿瘤根治术后急性肾损伤的危险因素  

Risk factors for postoperative acute kidney injury in patients undergoing radical resection of malignant colorectal cancer

作　　者：谢乙宁 于玲[1] 谭宏宇[1] Xie Yining;Yu Ling;Tan Hongyu(Department of Anesthesiology,Beijing Cancer Hospital,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院麻醉科,100142

出　　处：《中华麻醉学杂志》2021年第4期430-433,共4页Chinese Journal of Anesthesiology

摘　　要：目的筛选结直肠恶性肿瘤根治术后急性肾损伤(AKI)的危险因素。方法回顾性收集2019年11月1日至2020年12月1日行结直肠恶性肿瘤根治术患者的病历资料,包括性别、年龄、身高、体重、ASA分级、合并疾病(高血压、糖尿病、冠心病、术前慢性肾脏疾病和肾功能不全)、术前新辅助治疗情况、术前血肌酐水平(术前1~3 d内)、术前预防性输尿管插管情况、手术方式、术中出血量和输血情况、术中补液量和尿量、术中低血压发生情况和持续时间、术中预防性回肠造口、手术时间、术后住院时间、术后并发症(肠梗阻、吻合口漏/腹腔感染)发生情况、术后抗生素和NSAIDs使用情况。采用KDIGO标准诊断术后AKI,根据术后7 d内是否发生AKI分为AKI组和非AKI组,并采用Poisson回归分析筛选术后AKI的危险因素。结果最终共纳入543例患者,有14例发生术后AKI,发生率为2.6%。Poisson回归分析显示,术前合并高血压(OR值5.04,95%可信区间1.57~22.18,P=0.041)和术后使用万古霉素(OR值8.87,95%可信区间2.27~28.99,P=0.004)是结直肠恶性肿瘤根治术后AKI的独立危险因素。结论术前合并高血压和术后使用万古霉素是结直肠恶性肿瘤根治术后AKI的独立危险因素。Objective To identify the risk factors for postoperative acute kidney injury(AKI)in patients undergoing radical resection of malignant colorectal cancer.Methods Patients undergoing radical resection of malignant colorectal cancer from November 1,2019 to December 1,2020,were selected,and the medical records including gender,age,height,weight,American Society of Anesthesiologists(ASA)physical status,complications(hypertension,diabetes mellitus,coronary heart disease,chronic kidney disease and renal insufficiency),neoadjuvant therapy before surgery,preoperative serum creatinine level(within 1-3 days before surgery),preoperative prophylactic ureteral intubation,operation methods,intraoperative blood loss and blood transfusion,intraoperative fluid infusion and urine output,intraoperative hypotension occurrence and duration,intraoperative prophylactic ileostomy,operation time,postoperative length of stay,postoperative complications(ileus,anastomotic leak/abdominal infection),postoperative antibiotics and nonsteroidal anti-inflammatory drugs use were retrospectively collected.Postoperative AKI was diagnosed based on Kidney Disease Improving Global Outcomes criteria.The patients were divided into AKI group and non-AKI group according to whether postoperative AKI occurred within 7 days after surgery,and the risk factors for postoperative AKI were screened by multivariate Poisson regression analysis.Results A total of 543 patients were included in this study.There were 14 cases of postoperative AKI and the incidence was 2.6%.Poisson regression analysis showed that preoperative hypertension(OR=5.04,95%confidence interval 1.57-22.18,P=0.041)and postoperative use of vancomycin(OR=8.87,95%confidence interval 2.27-28.99,P=0.004)were the independent risk factors for postoperative AKI.Conclusion Preoperative hypertension and postoperative use of vancomycin are the independent risk factors for postoperative AKI in patients undergoing radical resection of malignant colorectal cancer.

关 键 词：急性肾损伤 手术并发症 结直肠肿瘤 危险因素 

分 类 号：R735.35[医药卫生—肿瘤]