胰十二指肠切除术后急性肾损伤的危险因素分析

Risk factors for acute kidney injury after open pancreaticoduodenectomy

目的探讨开腹胰十二指肠切除术后急性肾损伤(acute kidney injury, AKI)的危险因素。方法回顾性分析2011年11月-2018年4月行开腹胰十二指肠切除术患者389例,男219例,女170例,年龄25~79岁,ASAⅠ-Ⅳ级。收集相关围术期资料,统计术后AKI、性别、BMI、合并梗阻性黄疸、服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)类降压药和术后Hb等情况。采用多因素Logistic回归分析术后AKI的独立危险因素。结果术后AKI有46例(11.8%)。多因素Logistic回归分析显示,男性(OR=2.33,95%CI 1.13~4.82,P=0.023)、BMI≥24 kg/m^2(OR=2.39,95%CI 1.23~4.65,P=0.010)、合并梗阻性黄疸(OR=3.29,95%CI 1.70~6.37,P<0.001)、服用ACEI或ARB(OR=3.93,95%CI 1.08~14.38,P=0.038)和术后Hb中重度下降(OR=3.81,95%CI 1.13~12.89,P=0.031)是开腹胰十二指肠切除术后AKI的独立危险因素。结论男性、BMI≥24 kg/m^2、合并梗阻性黄疸、服用ACEI或ARB、术后Hb中重度下降是开腹胰十二指肠切除术后AKI的独立危险因素。

Objective To examine the incidence and risk factors of patients who developed acute kidney injury(AKI) after open pancreaticoduodenectomy. Methods A total of 389 patients who underwent open pancreaticoduodenectomy between November 2011 and April 2018 at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were enrolled, 219 males and 170 females, aged 25-79 years, ASA Ⅰ-Ⅳ. Patients′ demographics, clinical history, preoperative medications, tumor characteristics, laboratory results, intraoperative variables and postoperative variables were collected. Risk factors of AKI after the surgery were evaluated using multiple logistic regression analysis. Results Out of 389 patients, 46(11.8%) developed postoperative AKI. Logistic regression model demonstrated that male(OR=2.33, 95%CI 1.13-4.82, P = 0.023), body mass index(BMI)≥24 kg/m^2(OR=2.39, 95%CI 1.23-4.65, P = 0.010), obstructive jaundice(OR=3.29, 95%CI 1.70-6.37, P < 0.001), angiotensin-converting enzyme inhibitors(ACEI)or angiotensin receptor blocker(ARB)(OR=3.93, 95%CI 1.08-14.38, P = 0.038) and severe or moderate postoperative hemoglobin(Hb) decline(OR=3.81, 95%CI 1.13-12.89, P = 0.031)were independent predictors of postoperative AKI. Conclusion AKI is not an uncommon complication after open pancreaticoduodenectomy and may be closely associated with male, BMI≥24 kg/m^2, obstructive jaundice, ACEI or ARB and severe or moderate postoperative Hb decline.