术中液体平衡对肠外瘘确定性手术病人术后早期肾功能的影响  

Effects of intraoperative fluid balance on renal function in the early postoperative period in patients undergoing definitive surgery for enterocutaneous fistula

作　　者：章杰 吴智方 张文豪 崔立颖 洪之武 王革非 嵇晴 ZHANG Jie;WU Zhi-fang;ZHANG Wen-hao;CUI Li-ying;HONG Zhi-wu;WANG Ge-fei;JI Qing(Department of Anesthesiology,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,Jiangsu,China;Research Institute of General Surgery,Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院/东部战区总医院麻醉科,江苏南京210002 [2]南京大学医学院附属金陵医院/东部战区总医院全军普通外科研究所,江苏南京210002

出　　处：《肠外与肠内营养》2023年第4期212-220,共9页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金面上项目(81870396,82170581);江苏省自然科学基金面上项目(BK20211133)。

摘　　要：目的:分析术中液体输注量对行肠外瘘确定性手术病人术后早期肾功能的影响,并探讨肠外瘘确定性手术后出现急性肾功能损伤(AKI)的危险因素。方法:回顾性分析2021年6月至2023年3月南京大学医学院附属金陵医院243例行肠外瘘确定性手术病人的围手术期临床资料。根据术中液体输注量将入组病人分为相对限制性输液组、常规输液组及相对开放性输液组,比较三组病人围手术期指标的差异,并筛选出行肠外瘘确定性手术病人术后AKI的独立危险因素。结果:研究共纳入243例病人。相对限制性输液组、常规输液组及相对开放性输液组术后AKI的发生率分别为11.1%(9/81)、7.4%(6/81)和11.1%(9/81),三组间差异无统计学意义(P> 0.05)。根据术后是否出现AKI,将病人分为正常组(n=219)与AKI组(n=24),两组间的性别、BMI、术前血肌酐(Scr)水平等资料均无统计学差异(P> 0.05),而年龄、高血压病史、术前血尿素氮(BUN)水平、手术时间、术中晶体输注量、术中出血量、术中输血量及术后钠钾最大变化量等有统计学意义(P <0.05)。Logistic回归分析结果显示,高血压病史、术前BUN水平、术中出血量及术后钠钾最大变化量为肠外瘘确定性手术后病人AKI的独立危险因素(P <0.05)。基于以上独立危险因素,建立预测肠外瘘确定性手术后病人AKI的风险列线图模型。结论:在维持循环稳定与保证器官灌注的前提下,术中液体输注量与肠外瘘确定性手术后早期AKI的发生无明显关联性。减少术中出血量以及密切监测围术期电解质及肾功能变化是降低肠外瘘确定性手术后AKI发生率的重要措施。Objective:To analyze the effect of intraoperative fluid infusion on early postoperative renal function in patients who underwent definitive surgery for enterocutaneous fistula,and to explore the risk factors for acute kidney injury(AKI) after definitive surgery for enterocutaneous fistula resection.Methods:The perioperative clinical data of 243 patients who underwent definitive surgery for extra-intestinal fistula in Jinling Hospital from June 2021 to March 2023 were retrospectively analyzed.The enrolled patients were divided into relatively restrictive infusion group,routine infusion group and relatively open infusion group according to the intraoperative fluid infusion volume,and the differences of perioperative indicators among the three groups were compared by ANOVA.Logistic regression analysis was used to screen independent risk factors for postoperative acute kidney injury in patients undergoing surgery for enterocutaneous fistula according to whether postoperative acute kidney injury occurred.Results:A total of 243patients were included.The incidence of postoperative acute kidney injury was 11.1%(9/81),7.4%(6/81) and 11.1%(9/81) in the relatively restricted infusion group,conventional infusion group and relatively open infusion group,respectively,and the difference was not statistically significant(P>0.05).Patients were divided into normal group(n =219) and AKI group(n = 24) according to whether they developed AKI after surgery,,and there were no statistically significant differences between the two groups in terms of gender,BMI,preoperative Scr level,whereas the age,history of hypertension,preoperative blood urea nitrogen(BUN) level,duration of surgery,intraoperative crystalloid transfusion volume,intraoperative bleeding,intraoperative blood transfusion,and maximum postoperative sodium and potassium change were statistically significant(P>0.05).Logistic regression analysis showed that history of hypertension,preoperative BUN level,intraoperative bleeding and maximum change in sodium and potassium after su

关 键 词：肠瘘 液体平衡 电解质平衡 急性肾功能损伤 危险因素 

分 类 号：R614[医药卫生—麻醉学] R574[医药卫生—外科学]