口腔颌面-头颈恶性肿瘤术后急性肾损伤的发生率及危险因素分析  

The incidence and risk factors of acute kidney injury after surgery for oromaxillofacial head and neck tumor

作　　者：李萍[1] 罗涛 黄灿 周驰[1] 孙宇[1] LI Ping;LUO Tao;HUANG Can;ZHOU Chi;SUN Yu(Department of Anesthesiology,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《中国口腔颌面外科杂志》2023年第4期384-389,共6页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的:明确口腔颌面-头颈恶性肿瘤术后急性肾损伤(acute kidney injury,AKI)的发生率并分析相关危险因素。方法:回顾性分析上海交通大学医学院附属第九人民医院2014年1月—2021年12月接受口腔颌面-头颈恶性肿瘤切除手术的患者,收集围术期资料。根据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)标准,术后48 h内血清肌酐升高≥26.5μmol/L或7天内血清肌酐升高≥1.5倍基础值定义为AKI。根据术后是否发生AKI分为2组—AKI组和非AKI组。统计术后AKI发生率,比较2组术后机械通气使用率、死亡率、ICU停留时间、住院时间和住院费用。采用SPSS 26.0软件包中的Logistic回归分析确定术后AKI的独立危险因素。结果:最终纳入6830例患者(男4238例,女2592例;平均年龄59.3岁)。134例(2.0%)患者术后发生AKI,其中AKI 1、2、3级分别为129例、4例、1例。多因素Logistic回归分析显示,女性(OR=2.166,95%CI:1.440~3.259)、非甾体抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)(OR=2.305,95%CI:1.088~4.883)、贫血(OR=1.688,95%CI:1.132~2.517)、蛋白尿(OR=2.080,95%CI:1.242~3.482)、长时间麻醉(OR=0.346,95%CI:0.196~0.612)是术后发生AKI的独立影响因素。AKI组患者在住院期间有更高的死亡率(1.0%),但AKI并不影响临床结局。结论:口腔颌面-头颈恶性肿瘤术后AKI的发生率约为2.0%,女性、NSAIDs、贫血、蛋白尿、长时间麻醉与AKI的发生独立相关。PURPOSE:To determine the incidence and risk factors of acute kidney injury(AKI)in patients undergoing surgery for oromaxillofacial head and neck tumors.METHODS:Patients undergoing surgery for oromaxillofacial head and neck cancer from January 2014 to December 2021 at Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine were collected and retrospectively analyzed.AKI was defined an absolute increase in plasma creatinine of 26.5μmol/L within 48 h or a 1.5 times increase in creatinine within 7 days according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Two groups were divided according to whether AKI occurred after surgery:AKI group and non-AKI group.The incidence of postoperative AKI was calculated,and the rates of postoperative mechanical ventilation,mortality,ICU stay,length of hospital stay and hospital costs were compared between the two groups.Logistic regression analysis was performed to identify independent risk factors for AKI with SPSS 26.0 software package.RESULTS:A total of 6830 patients(mean age 59.3 years,4238 men and 2592 women)were included.Postoperative AKI was observed in 134(2.0%)patients,with stage 1,2 and 3 AKI in 129,4 and 1,respectively.Multivariate logistic analysis revealed that female(OR=2.166,95%CI:1.440-3.259),non-steroidal anti-inflammatory drugs(NSAIDs)(OR=2.305,95%CI:1.088-4.883),anemia(OR=1.688,95%CI:1.132-2.517),albuminuria(OR=2.080,95%CI:1.242-3.482)and prolonged anesthesia(OR=0.346,95%CI:0.196-0.612)were independently associated with the development of AKI.Patients in the AKI group had a higher mortality rate(1.0%)during hospitalization,but AKI did not impact clinical outcomes.CONCLUSIONS:Postoperative AKI occurred in 2.0%of patients after oromaxillofacial head and neck tumor surgery.Female,NSAIDs,anemia,albuminuria and long-term anesthesia were independent risk factors for postoperative AKI.

关 键 词：口腔颌面-头颈恶性肿瘤 急性肾损伤 危险因素 KDIGO标准 

分 类 号：R730.6[医药卫生—肿瘤]