神经外科手术患者急性肾损伤的发生率及危险因素分析

Incidence and risk factors of acute kidney injury in patients undergoing neurosurgery

目的分析神经外科手术患者急性肾损伤(acute kidney injury,AKI)的发生率及危险因素。方法本研究为单中心、回顾性研究。研究对象为2017年1月1日至2020年12月31日因颅内肿瘤和颅内血管疾病在首都医科大学宣武医院神经外科普通病房住院治疗的患者,收集入选者人口学、临床资料及实验室检查结果。根据AKI诊断标准将患者分为AKI组和非AKI组,比较两组患者临床参数以及用药的差异。采用Logistic回归模型分析神经外科手术患者发生AKI的危险因素。结果纳入神经外科手术患者4509例,年龄(51.93±16.03)岁,男性2361例,女性2148例,AKI发生率为3.37%(152/4509),其中因颅内肿瘤手术的患者AKI发生率为3.69%(84/2278),因颅内血管疾病手术的患者AKI发生率为3.05%(68/2231)。AKI组患者平均住院时间(t=4.897,P<0.001)和手术时间(t=5.496,P<0.001)均长于非AKI组。AKI组患者中合并糖尿病比例、术前血肌酐、血尿素氮、糖化血红蛋白、血乳酸、纤维蛋白原及收缩压水平均显著高于非AKI组,血红蛋白水平显著低于非AKI组(均P<0.05)。AKI组患者中应用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂、头孢类抗生素、质子泵抑制剂类药物、甘露醇和非甾体抗炎药的比例也显著高于非AKI组(均P<0.05)。多因素Logistic回归分析结果显示,血红蛋白<110 g/L(OR=4.252,95%CI 1.569~11.527,P=0.004)、术前血尿素氮升高(OR=1.304,95%CI 1.139~1.492,P<0.001)和应用非甾体抗炎药(OR=2.342,95%CI 1.044~5.253,P=0.039)为神经外科手术患者发生AKI的独立危险因素。结论神经外科普通病房住院患者AKI的发生率为3.37%。贫血、血尿素氮升高以及应用非甾体抗炎药为神经外科手术患者AKI的独立危险因素。

Objective To analyze the incidence and risk factors of acute kidney injury(AKI)in patients undergoing neurosurgery.Methods This study was a single center and retrospective research.The patients hospitalized in the general neurosurgery ward of Xuanwu Hospital,Capital Medical University,due to intracranial tumors and intracranial vascular diseases from January 1,2017 to December 31,2020 were enrolled.Demographic,clinical data and laboratory examination results of the selected patients were collected.The patients were divided into AKI group and non-AKI group according to AKI diagnosis criteria,and the differences of clinical parameters and medication between the two groups were compared.Logistic regression analysis method was used to analyze the risk factors of AKI in neurosurgical patients.Results Among 4509 patients undergoing neurosurgery with age of(51.93±16.03)years old,2361 males and 2148 females,152 patients(3.37%)had AKI.The incidence of AKI in patients undergoing intracranial tumor surgery was 3.69%(84/2278),and the incidence of AKI in patients undergoing intracranial cerebrovascular surgery was 3.05%(68/2231).The length of hospital stay(t=4.897,P<0.001)and operation time(t=5.496,P<0.001)in AKI group were significantly longer than those in non-AKI group.The proportions of diabetes mellitus,preoperative serum creatinine,blood urea nitrogen,glycosylated hemoglobin,lactic acid,fibrinogen,and systolic pressure levels in AKI group were significantly higher than those in non-AKI group(all P<0.05);the hemoglobin level in AKI group was significantly lower than that in non-AKI group(P<0.05).The proportions of patients using angiotensin converting enzyme inhibitors/angiotensinⅡreceptor antagonists,cephalosporins,proton pump inhibitors,mannitol,and nonsteroidal anti-inflammatory drugs in AKI group were also significantly higher than those in non-AKI group(all P<0.05).Multivariate logistic regression analysis results showed that hemoglobin<110 g/L(OR=4.252,95%CI 1.569-11.527,P=0.004),elevated blood urea nitrogen(OR=1.304,95%CI 1.139-1.492,P<0.001)and application of nonsteroidal anti-inflammatory drugs(OR=2.342,95%CI 1.044-5.253,P=0.039)were independent risk factors of AKI in neurosurgical patients.Conclusions The incidence of AKI in patients in neurosurgery general ward is 3.37%.Anemia,elevated blood urea nitrogen and application of nonsteroidal anti-inflammatory drugs are independent risk factors of AKI in patients undergoing neurosurgery.