基于数据平台的全麻非心脏手术患者术后急性肾损伤危险因素分析

Data platform-based analysis of risk factors for acute renal injury after non-cardiac surgery under general anesthesia

目的分析全麻非心脏手术患者术后发生急性肾损伤(AKI)的危险因素。方法基于麻醉与围手术期医学专科数据平台,回顾性收集2019年1月-2021年5月广东省第二人民医院收治的全麻Ⅲ-Ⅳ级非心脏手术患者的临床资料。根据改善全球肾脏病预后组织(KDIGO)的AKI诊断标准,筛选出数据相对完整的205例术后发生AKI(设为术后AKI组)和251例术后无AKI患者(设为术后无AKI组),采用单因素及多因素logistic回归分析术后AKI的危险因素。结果与术后无AKI组比较,术后AKI组术前红细胞计数,血红蛋白、白蛋白水平,以及初始平均动脉压较低(P<0.05);术前肌酐、D-二聚体、C反应蛋白(CRP)、纤维蛋白原水平,术中总出量,以及美国麻醉医师协会(ASA)分级Ⅲ-Ⅳ级比例较高(P<0.05)。多因素logistic回归分析显示,术前血红蛋白水平、初始平均动脉压及术前肌酐水平是术后AKI的独立危险因素(OR=0.958、0.976、1.021,P<0.05)。结论全麻非心脏Ⅲ-Ⅳ级手术患者术后AKI的发生与术前血红蛋白水平、术前肌酐水平及初始平均动脉压有关,值得进一步大数据研究。

Objective To analyze the possible risk factors for postoperative acute kidney injury(AKI)in patients undergoing non-cardiac surgery under general anesthesia.Methods Based on anesthesia and perioperative medical specialty data platform,the clinical data were retrospectively collected of patients with general anesthesia gradeⅢ-Ⅳnon-cardiac surgery who were admitted to the Guangdong Second Provincial General Hospital from January 2019 to May 2021.According to the AKI diagnostic criteria of Kidney Disease:Improving Global Outcomes(KDIGO),205 patients with relatively complete data were screened and set as postoperative AKI group,and 251 patients without postoperative AKI were set as non-postoperative AKI group.Univariate and multivariate logistic regression analysis were performed to identify the risk factors of postoperative AKI.Results Compared with non-postoperative AKI group,patients in postoperative AKI group had lower preoperative erythrocytes,hemoglobin,albumin and initial mean arterial pressure(P<0.05).Preoperative creatinine,D-dimer,C-reactive protein(CRP),fibrinogen,total intraoperative output and American Society of Anesthesiologists(ASA)physical status classification were higher(P<0.05).Multivariate logistic regression analysis showed that preoperative hemoglobin,initial mean arterial pressure and preoperative creatinine level were independent risk factors for postoperative AKI(OR=0.958,0.976 and 1.021 respectively,P<0.05).Conclusion The occurrence of postoperative AKI in patients undergoing non-cardiac surgery of grade III-IV under general anesthesia is related to preoperative hemoglobin level,preoperative creatinine level and initial mean arterial pressure,which is worth further big data research.