关节置换术后急性肾损伤的研究进展

Research progress on acute kidney injury after joint replacement

外科手术后急性肾损伤(acute kidney injury, AKI)是一组以肾功能短期急剧下降为特征的临床综合征,全球每年约有170万人死于AKI。关节置换手术过程中,患者常伴随体位变化、术中大量出血及严重的应激反应,极易发生术后AKI。外科手术后AKI与医疗资源占用率、患病率及病死率增加有关。目前,关于AKI诸多危险因素仍存在争议,相关机制尚未明确。文章简述关节置换术后AKI流行病学、诊断标准,加深临床医师对这一常见并发症的认识;并通过回顾近几年国际上相关文献,对关节置换术后AKI的围手术期高危因素及防治现状进行综述,旨在为提高临床管理水平提供指导依据,进而减少术后AKI的发生。

Postoperative acute kidney injury(AKI)is a group of complex clinical syndromes,characterized by an abrupt decline of renal function,and about 1.7 million people die from AKI every year worldwide.Postoperative AKI after joint replacement is quite common,as patients are often accompanied by postural changes,heavy bleeding and severe stress response during operation.AKI is associated with increased resource utilization,mortality and risk of death.At present,there are still controversies about the risk factors of AKI,and the relevant mechanisms are not fully understood.This article reviews the epidemiology and diagnostic criteria of AKI to deepen clinicians'understanding towards this common complication;based on recent international literatures,this article summarizes the perioperative high-risk factors and the current prevention and treatment of AKI after joint replacement,so as to improve clinical management and consequently reduce the occurrence of postoperative AKI.