老年患者胰十二指肠切除术后急性肾损伤的发生率及其危险因素

Incidence of acute kidney injury following pancreaticoduodenectomy and related risk factors in elderly patients

目的探讨老年患者行胰十二指肠切除术后急性肾损伤(acute kidney injury,AKI)的发生率及危险因素。方法回顾性收集2017年1月至2020年6月在河南省人民医院行胰十二指肠切除术的老年患者的临床资料,根据术后48 h或7 d内血清肌酐值的变化程度将患者分为AKI组和非AKI组,比较两组患者的临床基本特征,计算患者AKI的发生率。使用多因素Logistic回归模型分析患者发生术后AKI的危险因素。结果共纳入322例患者,年龄(67.1±5.2)岁(60~85岁),男性186例(57.76%),其中41例(12.73%)患者发生术后AKI。与非AKI组患者相比,AKI组患者血清总胆红素水平较高(Z=-2.012,P=0.044),血红蛋白水平较低(Z=-2.111,P=0.035)。多因素Logistic回归分析显示,术前总胆红素增高(OR=1.003,95%CI 1.000~1.006,P=0.027)和术后行剖腹探查术(OR=3.936,95%CI 1.071~14.460,P=0.039)是老年患者胰十二指肠切除术后并发AKI的独立影响因素。结论老年患者胰十二指肠切除术后AKI的发生率为12.73%。术前高胆红素以及术后行剖腹探查术可能是老年胰十二指肠切除术患者并发AKI的独立危险因素。

Objective To investigate the incidence of acute kidney injury(AKI)following pancreaticoduodenectomy and related risk factors in elderly patients.Methods The clinical data of elderly patients who underwent pancreaticoduodenectomy in Henan Provincial People′s Hospital from January 2017 to June 2020 were collected retrospectively.According to the changes of serum creatinine within 48 h or 7 days after operation,the patients were divided into AKI group and non⁃AKI group.The basic clinical characteristics of the two groups were compared,and the incidence of AKI was calculated.Multivariate logistic regression model was used to analyze the risk factors of postoperative AKI.Results A total of 322 elderly patients were enrolled,with age of(67.1±5.2)years old(60-85 years old)and 186 males(57.76%).Among 322 elderly patients,there were 41 patients(12.73%)suffering from AKI following pancreaticoduodenectomy.Compared with the non⁃AKI group,the level of bilirubin in AKI group was higher(Z=-2.012,P=0.044),and the level of hemoglobin in AKI group was lower(Z=-2.111,P=0.035).Multivariate logistic regression analysis showed that increased preoperative total bilirubin(OR=1.003,95%CI 1.000-1.006,P=0.027)and postoperative exploratory laparotomy(OR=3.936,95%CI 1.071-14.460,P=0.039)were the independent influencing factors for AKI after pancreaticoduodenectomy in elderly patients.Conclusions The incidence of AKI after pancreaticoduodenectomy in elderly patients is 12.73%.Preoperative high bilirubin and postoperative exploratory laparotomy may be the independent risk factors for AKI after pancreaticoduodenectomy in elderly patients.