个性化血压管理策略对老年胃肠手术后急性肾损伤的影响

Influence of individualised blood pressure management strategy on postoperative acute kidney injury in the elderly patients who underwent gastrointestinal surgery

目的探讨个性化血压管理策略对老年胃肠手术后急性肾损伤的影响,以期为降低急性肾损伤发生率提供一定的临床数据。方法选择2018年9月—2019年12月安徽医科大学第一附属医院择期行胃肠手术的患者166例,采用随机数字表法随机分为个性化血压管理策略组(IM组,84例)与标准血压管理策略组(CON组,82例)。比较2组患者各时点平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、肌酐(CRE)、血尿素氮(BUN)和估算肾小球滤过率(eGFR)以及急性肾损伤(AKI)的发生率。结果2组患者一般资料比较差异无统计学意义(均P>0.05)。手术麻醉过程中,2组MAP(气管插管前至术毕)、SBP(气管插管前至术毕)、DBP(切皮后1 h)比较差异有统计学意义(|t|>2.330,均P<0.05)。2组患者CRE均随时间改变,差异有统计学意义(F=188.547,P<0.001)。2组BUN随时间无明显改变,差异无统计学意义(F=1.919,P=0.125)。2组eGFR术后较术前均上升,但组间差异无统计学意义(F=1.121,P=0.291)。IM组发生AKI 3例(3.6%),CON组发生AKI共10例(12.2%),2组AKI的发生率差异有统计学意义(χ^(2)=4.275,P=0.039)。结论采用个性化血压管理策略有助于降低老年胃肠手术后急性肾损伤的发生率。

Objective To explore the effect of individualised blood pressure management strategy on postoperative acute kidney injury(AKI)in elderly patients who underwent gastrointestinal surgery to provide certain clinical data for reducing the incidence of AKI.Methods A total of 166 patients who underwent elective gastrointestinal surgery in the First Affiliated Hospital of Anhui Medical University from September 2018 to December 2019 were selected.The patients were randomly divided into individualised blood pressure management group(IM group,n=84)and standard blood pressure management strategy group(CON group,n=82).The mean arterial pressure(MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP),creatinine(CRE),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)and incidence of AKI(acute kidney injury)were observed at each time point in the two groups.Results No statistically significant difference was found in the general data between the two groups(P>0.05).During the operation,two groups of the MAP,SBP(before endotracheal intubation to at the end of the operation)and DBP(one hour after the operation)comparative difference was statistically significant(|t|>2.330,all P<0.05).The levels of serum creatinine in both groups changed with time and the difference was statistically significant(F=188.547,P<0.001).The values of BUN did not significantly change with time but with statistical difference between the two groups(F=1.919,P=0.125).The postoperative value of eGFR increased in both groups compared with the preoperative value but no statistical difference was observed(F=1.121,P=0.291).However,a statistical difference was found in the number of AKI between the two groups[3(3.6%)vs.10(12.2%),χ^(2)=4.275,P=0.039].Conclusion Individualised blood pressure management strategy is helpful to reduce the incidence of AKI after gastrointestinal surgery in the elderly.