腹膜后肿瘤切除术后发生急性肾损伤预后因素的多因素分析

Multivariate Analysis on Prognostic Factors of Acute Kidney Injury After Retroperitoneal Tumors Resection

目的探讨腹膜后肿瘤(retroperitoneal tumors,RPTs)切除术后发生急性肾损伤(acute kidney injury,AKI)的预后因素。方法应用我院临床数据中心系统筛选2019年1月~2022年3月择期RPTs完全切除手术患者,按照纳入和排除标准,共纳入320例,其中40例术后发生AKI,对性别、年龄、BMI、ASA分级、术前合并症、术前C反应蛋白、血红蛋白、白蛋白、既往肾切除史、既往RPTs手术史、麻醉时间、手术时间、术中肾切除、组织分型、出血量、术中低体温、术中血糖最高值、术中乳酸最高值、术中低血压、术中持续泵注去甲肾上腺素、速尿使用、术中输注红细胞>2000 ml、术中输注血浆>1000 ml等进行单因素分析,有统计学差异的变量进行多因素logistic回归分析,筛选发生AKI的预后因素。结果单因素分析显示患者年龄≥60岁、术中肾切除、术中出血量>2000 ml、术中低血压、术中持续泵注去甲肾上腺素≥0.05μg•kg^(-1)•min^(-1)、术中输注红细胞>2000 ml、术中输血浆>1000 ml差异有统计学意义(P<0.05)。多因素logistic回归分析显示:术中肾切除(OR=7.710,95%CI:3.407~17.450)和术中低血压(OR=3.699,95%CI:1.710~8.002)是术后发生AKI的独立预后因素。40例AKI中28例发生术中低血压,其中16例MAP 55~65 mm Hg持续时间超出20 min,6例MAP<55 mm Hg持续时间>10 min。结论RPTs切除术的围术期麻醉管理要避免长时间术中低血压甚至严重低血压,对肾切除患者应重视优化麻醉对循环的管理,对于预防术后发生AKI非常重要。

Objective To explore prognostic factors of postoperative acute kidney injury(AKI)in patients with retroperitoneal tumors resection.Methods From January 2019 to March 2022,clinical medical records of patients who underwent retroperitoneal tumors resection were retrospectively selected by the clinical data center system of our hospital.According to the inclusion and exclusion criteria,a total of 320 patients were analyzed,40 of which developed AKI within 48 hours.Univariate analysis was made on gender,age,BMI,ASA classification,preoperative comorbidities,preoperative C reactive protein,hemoglobin,albumin,previous nephrectomy history,previous retroperitoneal tumors operation history,anesthesia time,operation time,intraoperative nephrectomy,tissue typing,blood loss,intraoperative hypothermia,intraoperative maximum blood glucose,intraoperative maximum lactate,intraoperative hypotension,intraoperative continuous pumping of norepinephrine,furosemide use,intraoperative red blood cell transfusion>2000 ml,intraoperative plasma transfusion>1000 ml and other relevant data to select the significant difference factors.Multivariate logistic regression analysis was made among variables with statistical significance to identify the independent prognostic factors of AKI.Results Univariate analysis showed significant differences in factors including age≥60 years old,intraoperative nephrectomy,intraoperative blood loss>2000 ml,intraoperative hypotension,continuous pumping of norepinephrine≥0.05μg•kg^(-1)•min^(-1),intraoperative red blood cell transfusion>2000 ml,and intraoperative plasma transfusion>1000 ml(P<0.05).Multivariate logistic analysis showed that intraoperative nephrectomy(OR=7.710,95%CI:3.407-17.450)and intraoperative hypotension(OR=3.699,95%CI:1.710-8.002)were independent prognostic factors of postoperative AKI.Among the 40 cases of AKI,28 cases developed intraoperative hypotension,of which 16 cases had MAP 55-65 mm Hg lasting for more than 20 min and 6 cases had MAP<55 mm Hg lasting for more than 10 min.Conclusions Perioperative anesthesia management of retroperitoneal tumors resection should avoid long-term intraoperative hypotension or severe hypotension.For patients receiving nephrectomy,optimizing circulation management during the surgery should be paid attention to,which is very important for preventing the occurrence of postoperative AKI.