术后尿蛋白水平对非心脏手术危重症患者急性肾损伤的预测价值  

Effects of postoperative urine protein levels on predicting acute kidney injury in critically ill patients undergoing non-cardiac surgery

作　　者：池东璇 李楠[1] 周炜杰 袁翠[1] 谢旻[1] 李卓[2] 汪润[3] 屈晨雪[3] 李雪迎[4] 李双玲[1] 杨莉[2] 王东信[5] Chi Dongxuan;Li Nan;Zhou Weijie;Yuan Cui;Xie Min;Li Zhuo;Wang Run;Qu Chenxue;Li Xueying;Li Shuangling;Yang Li;Wang Dongxin(Department of Critical Care Medicine,Peking University First Hospital,Beijing 100034,China;Department of Nephrology,Peking University First Hospital,Beijing 100034,China;Clinical Laboratory,Peking University First Hospital,Beijing 100034,China;Department of Biostatistics,Peking University First Hospital,Beijing 100034,China;Department of Anesthesiology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院重症医学科,北京100034 [2]北京大学第一医院肾脏内科,北京100034 [3]北京大学第一医院检验科,北京100034 [4]北京大学第一医院医学统计室,北京100034 [5]北京大学第一医院麻醉科,北京100034

出　　处：《中华医学杂志》2022年第5期336-343,共8页National Medical Journal of China

基　　金：北京大学第一医院交叉临床研究专项基金(2018CR32)。

摘　　要：目的分析术后尿蛋白水平对非心脏手术危重症患者发生术后急性肾损伤(AKI)的预测价值。方法连续收集2019年5月20日至2020年11月24日在北京大学第一医院重症医学科进行诊疗的661例危重症患者。记录患者年龄、性别、实验室检查等基线资料,术中、术后信息及患者预后等临床资料。采用2012年改善全球肾脏病预后组织(KDIGO)指南AKI诊断标准诊断术后AKI的发生。采用多因素logistic回归模型筛选影响危重症患者发生术后AKI的独立危险因素。结果661例危重症患者的年龄为(69±15)岁,AKI发生率为45.4%(300/661例)。多因素logistic回归结果显示:术后即刻尿蛋白半定量≥2+(OR=2.62,95%CI:1.05~6.56,P=0.039)是危重症患者发生AKI的独立危险因素。其他独立危险因素包括高龄(OR=1.04,95%CI:1.02~1.06,P=0.001)、高体质指数(BMI)(OR=1.12,95%CI:1.04~1.21,P=0.004)、术前血红蛋白水平低(OR=0.98,95%CI:0.97~1.00,P=0.019)、术后中心静脉压低(OR=0.89,95%CI:0.83~0.97,P=0.005)、术中及术后低血压时间长(OR=1.01,95%CI:1.00~1.01,P=0.041)。结论对于危重症患者,术后即刻尿蛋白半定量≥2+是发生AKI的独立危险因素。Objective To investigate the predictive value of postoperative urine protein level in critically ill patients undergoing non-cardiac surgery with acute kidney injury(AKI).Methods A total of 661 critically ill patients undergoing non-cardiac surgery,who visited the Department of Critical Care Medicine of Peking University First Hospital from May 20,2019 to November 24,2020,were enrolled in this prospective study.The clinical data of the patient′s age,gender,body mass index,laboratory examination,surgical status,etc.were collected.AKI diagnostic criteria of the 2012 KDIGO guidelines were used to diagnose the occurrence of AKI after surgery.The independent predictors of AKI were determined by multivariate logistic regression.Results The age of this patient cohort was(69±15)years.The prevalence of AKI was 45.4%(300/661).Multivariate logistic regression showed that urine protein semi-quantitative≥2+(OR=2.62,95%CI:1.05-6.56,P=0.039)was independent factor for postoperative AKI in critically ill patients undergoing non-cardiac surgery,other independent factors include higher age(OR=1.04,95%CI:1.02-1.06,P=0.001),higher body mass index(BMI)(OR=1.12,95%CI:1.04-1.21,P=0.004),lower plasma hemoglobin level(OR=0.98,95%CI:0.97-1.00,P=0.019),lower central venous pressure(OR=0.89,95%CI:0.83-0.97,P=0.005)and lower total hypotension time(OR=1.01,95%CI:1.00-1.01,P=0.041).Conclusions Urine protein semi-quantitative≥2+after surgery is an independent predictive factor for the occurrence of postoperative AKI in critically ill patients undergoing non-cardiac surgery.It is important to check urine routine immediately after surgery to detect and deal with high-risk patients.

关 键 词：手术后期间 蛋白尿 非心脏手术 危重症患者 急性肾损伤 横断面研究 

分 类 号：R619[医药卫生—外科学] R692[医药卫生—临床医学]