术中血压管理对老年腹部大手术患者术后早期急性肾损伤的影响

Effect of intraoperative blood pressure management on early postoperative acute kidney injury in elderly patients undergoing major abdominal surgery

目的本文旨在探讨术中不同的血压管理对老年腹部大手术患者术后早期急性肾损伤的影响。方法选择择期腹部大手术患者164例,随机将患者分为两组:标准化管理组(S组,n=82),术中平均动脉压不低于65 mmHg或基础的80%;个体化管理组(I组,n=82),术中平均动脉压调控在基础值90%~110%范围内。观察并记录患者术前术后血肌酐和胱抑素C浓度,计算术后早期急性肾损伤发生率,评估不同平均动脉压调控水平对术后早期急性肾损伤的影响;记录术后收住ICU例数、术后住院时间及30 d死亡率,评估不同平均动脉压调控水平对患者预后的影响。结果与基础值相比,S组术后早期血肌酐及胱抑素C浓度升高(P<0.05);与S组比较,I组术后早期血肌酐及胱抑素C浓度显著降低、术后早期AKI发生率显著降低(P<0.05)。与S组比较,I组术后入住ICU率及术后住院时间显著减少(P<0.05)。结论术中MAP维持在基础值90%~110%可以降低老年腹部大手术患者术后早期急性肾损伤发生。

Objective This study aimed to explore the effect of intraoperative different blood pressure management on early acute kidney injury in elderly patients undergoing major abdominal surgery.Methods A total of 164 patients with elective major abdominal surgery were selected and randomly divided into two groups:standardized management group(group S,n=82,MAP was no less than 65 mmHg or 80%of the basic value)and individualized management group(group I,n=82,MAP regulation was in the range of 90%~110%of the basic value).The concentration of serum creatinine and cystatin C before and after operation were observed and recorded.The incidence of postoperative acute kidney injury was calculated and the influence of different blood pressure management on early postoperative acute kidney injury were evaluated.The number of patient admitted to ICU after surgery,postoperative hospital stay and the death rate within 30 days after operation were recorded,and the effect of different blood pressure management on the prognosis of elderly patients was evaluated.Results Compared with the basic values,the concentrations of serum creatinine and cystatin C were increased in the early postoperative period in groups(P<0.05);Compared with group S,the concentrations of serum creatinine and cystatin C in group I decreased after surgery,the incidence of AKI in early post-operation decreased significantly(P<0.05).Compared with group S,the number of patient admitted to ICU after surgery and hospital stays were significantly reduced in group I(P<0.05).Conclusions Maintaining MAP within 90%~110%of the basic value during surgery could reduce the incidence of early acute kidney injury in elderly patients undergoing major abdominal surgery.