重症患者非心脏大手术后早期外周灌注与急性肾损伤的关系  

The association between early peripheral perfusion and acute kidney injury in patients admitted to the intensive care unit following major noncardiac surgery

作　　者：崔玉健 李宇珂 朱赛楠[2] 李双玲[1] 李楠[1] CUI Yujian;LI Yuke;ZHU Sainan;LI Shuangling;LI Nan(Department of Critical Care Medicine,Peking University First Hospital,Beijing 100034,Beijing,China;不详)

机构地区：[1]北京大学第一医院重症医学科,北京100034 [2]北京大学第一医院医学统计室,北京100034

出　　处：《实用医学杂志》2025年第2期195-201,共7页The Journal of Practical Medicine

基　　金：国家临床重点专科建设项目(编号:2023-141);北京大学第一医院交叉临床研究专项(编号:2021CR35)。

摘　　要：目的 探讨重症患者非心脏大手术后早期外周灌注指数(peripheral perfusion index, PPI)与急性肾损伤(acute kidney injury, AKI)的相关性。方法 本研究为单中心回顾性队列研究,研究人群为非心脏大手术后即刻收入外科重症监护病房的患者,主要暴露因素为术后前6 h PPI,主要研究终点为术后7 d内AKI的发生。采用多因素logistic回归分析校正相关混杂因素,并以受试者工作特征(receiver operating characteristic, ROC)曲线寻找PPI的界值。结果 共有444例患者纳入本研究,术后AKI和严重AKI的发生率分别为9.23%、1.13%。术后早期PPI呈偏态分布[3.02(2.02,4.24)]。经多因素logistic回归分析后显示术后早期PPI(OR=0.734, 95%CI:0.580~0.930,P=0.010)与术后AKI的发生独立相关,ROC曲线下面积为0.680 2(95%CI:0.602 2~0.758 2,P <0.001)。以2.04为界值,术后早期PPI预测术后AKI的敏感度为53.7%,特异度为77.2%。进一步分析发现,术后早期PPI≤2.04的患者,其术后严重并发症的发生率更高,机械通气和术后住院时间更长。结论 术后早期PPI的下降与重症患者非心脏大手术后7 d内AKI的发生相关。Objective To investigate the association between early peripheral perfusion index(PPI)and acute kidney injury(AKI)in patients admitted to the intensive care unit(ICU)following major noncardiac surgery.Methods This retrospective cohort study was conducted at a single center.Adult patients consecutively enrolled were those admitted to the ICU after major noncardiac surgery.PPI measurements were collected within the first 6 hours post-surgery.The primary outcome assessed was the occurrence of AKI within 7 days after surgery.Multivariate logistic regression analysis was employed to adjust for confounding factors,while receiver operating characteristic(ROC)curve analysis determined the most predictive cutoff PPI.Results The study included a total of 444 patients who underwent noncardiac surgery.The incidences of postoperative AKI and severe AKI were 9.23%and 1.13%,respectively.Early postoperative PPI levels exhibited a skewed distribution,with a median value of 3.02(2.02,4.24).After adjusting for various perioperative variables,PPI was found to be indepen‐dently correlated with the occurrence of postoperative AKI(OR=0.734,95%CI:0.580~0.930,P=0.010),as indicated by an area under the ROC curve of 0.6802(95%CI:0.6022~0.7582,P<0.001).Using a cutoff value of≤2.04 for PPI,the sensitivity and specificity for predicting postoperative AKI were determined to be approximately at 53.7%and 77.2%respectively.Further analysis revealed that patients with PPI≤2.04 had a higher incidence of severe postoperative complications as well as prolonged mechanical ventilation duration and hospital stay.Conclusions A prompt reduction in postoperative PPI usage was found to be linked with the inci‐dence of AKI occurring within 7 days following major noncardiac surgery.

关 键 词：外周灌注指数 急性肾损伤 围术期并发症 预后 

分 类 号：R692.5[医药卫生—泌尿科学]