非小细胞肺癌术后并发急性肾功能不全的危险因素分析

The risk analysis of acute renal insufficiency in perioperative of non-small cell lung cancer

目的探讨非小细胞肺癌（NSCLC）术后发生急性肾功能不全（ARI）的危险因素。方法回顾性分析2007年1月至2013年10月同济医院胸外科收治的经手术和病理组织学确诊的1496例NSCLC患者，分为2组，依据肾功能不全的诊断标准从以上病例中筛选33例作为病例组，从剩余病例中筛选721例作为对照组，进行logistic回归分析。结果病例组与对照组在手术年龄、术前肌酐值、术前补液、术中血浆代用品的使用上差异有统计学意义。手术年龄／〉60岁和使用血浆代用品发生ARI的风险更高[调整OR为．93（1．30-6．62），95％CI为6．04（1．41～25．87）]。术前补液是发生ARI的保护因素（调整OR为0．37，95％C／为0．17-0．83）。结论NSCLC术后并发ARI的主要独立危险因素为手术年龄较大（i〉60岁）和术中血浆代用品的使用；术前适量补液可降低NSCLC术后ARI的发生率，为其保护因素。

Objective To discover the risk factors of acute renal insufficiency（ARI） in perioperative of non-small cell lung cancer（NSCLC）. Methods We took a retrospective study to analysis and summarize the clinical features of 33 ARI cases and 721 controls, all subjects were histopathologically confirmed NSCLC from January 2007 to October 2013. Logistic regres- sion analysis was conducted to analyze the association between the risk factors and ARI. Results There were significant differences between the two groups in operation age, level of preoperative creatinine, preoperative rehydration and the use of plasma substitutes. After adjustment by confounding factors, operation age older than 60 years old and the use of plasma substitutes had higher risk of ARI[ adjusted OR was 2.93 （ 1.30 - 6.62 ） , 95% CI was 6.04 （ 1.41 - 25.87 ） , respectively]. Preoperative rehydration was protective factor of ARI （ adjusted OR was 0.37, 95% CI was 0.17 - 0.83 ）. Conclusion Operation age（≥60 years old） and the use of blood substitutes are independent risk factors of ARI, while preoperative rehydration can reduce the incidence of ARI after surgery.