大型非心脏手术后急性肾损伤发生率及其相关危险因素分析

Analysis of the incidence of acute kidney injury and its associated risk factors after major non⁃cardiac surgery

目的探讨大型非心脏手术后急性肾损伤(AKI)的发生率及其相关危险因素。方法回顾性分析南方医科大学南方医院自2008年2月至2021年12月收治的进行大型非心脏手术治疗的24890例患者的临床资料。根据患者术后是否发生AKI,将患者分入非AKI组(术后未发生AKI)和AKI组(术后发生AKI)。比较非AKI组和AKI组的临床资料,采用Logistic回归分析AKI发生的危险因素。结果大型非心脏手术后发生AKI 1240例,发生率为4.98%(1240/24890);未发生AKI 23650例(95.02%,23650/24890)。两组年龄,性别,体质量指数,吸烟史,术前合并高血压、糖尿病、冠心病、心力衰竭、脑血管疾病(脑卒中或脑梗死等)、慢性肾病、慢性肝病比例,长期应用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、β⁃受体阻滞剂、利尿剂、钙通道阻滞剂、他汀类药物、胰岛素制剂比例,术前血清肌酐、血红蛋白、白蛋白、血清钠、血糖水平,美国麻醉医师协会分级,手术类型,手术时间,麻醉类型,有创动脉监测比例,平均动脉压,应用非甾体类消炎药比例,应用血管加压素比例,输液量,失血量,尿量,住院天数,术后发生感染、输血、卒中、心血管事件、死亡比例比较,差异均有统计学意义(P<0.05)。较高的年龄、男性、较大的体质量指数、合并心力衰竭、合并慢性肾病、应用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、应用钙通道阻滞剂、术前低白蛋白水平、术前高血糖水平、美国麻醉医师协会分级Ⅳ级、接受血管手术、接受腹部手术、较长的手术时间、较多的失血量是增加大型非心脏手术后AKI发生风险的危险因素(P<0.05),而应用他汀类药物是降低大型非心脏手术后AKI发生风险的保护因素(P<0.05)。结论大型非心脏手术后AKI的发生与高龄、男性、肥胖、合并心力衰竭和慢性肾病、应用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和钙通道阻滞剂、低白蛋白、高血糖、美国麻醉医师协会分级、手术类型、失血量及手术时间有关。

Objective To investigate the incidence and associated risk factors of acute kidney injury(AKI)after major non⁃cardiac surgery.Methods The clinical data of 24890 patients who underwent major non⁃cardiac surgery in Nanfang Hospital of Southern Medical University from February 2008 to December 2021 were retrospectively analyzed.Patients were divided into non⁃AKI group(no AKI after surgery)and AKI group(AKI after surgery)according to whether they developed AKI after surgery.The clinical data of non⁃AKI group and AKI group were compared,and the risk factors of AKI were analyzed by Logistic regression.Results AKI occurred in 1240 patients after major non⁃cardiac surgery,the incidence rate was 4.98%(1240/24890).AKI did not occur in 23650 cases(95.02%,23650/24890).There were statistically significant differences in age,sex,body mass index,smoking history,proportion of preoperative complications of hypertension,diabetes,coronary heart disease,heart failure,cerebrovascular disease(stroke or cerebral infarction,etc.),chronic kidney disease and chronic liver disease,proportion of long⁃term use of angiotensin⁃converting enzyme inhibitors/angiotensin receptor blockers,beta⁃blockers,diuretics,calcium channel blockers,statins,insulin preparations,preop⁃erative serum creatinine,hemoglobin,albumin,serum sodium,blood glucose levels,American College of Anesthetists grades,type of surgery,duration of surgery,type of anesthesia,proportion of invasive arterial monitoring,mean arterial pressure,proportion of non⁃ster⁃oidal anti⁃inflammatory drugs,proportion of vasopressin,transfusion volume,blood loss,urine volume,length of stay,incidence of infec⁃tion,blood transfusion,stroke,cardiovascular events and death in the two groups(P<0.05).Higher age,male,larger body mass index,combined heart failure,combined chronic kidney disease,use of angiotensin converting enzyme inhibitors/angiotensin receptor block⁃ers,use of calcium channel blockers,preoperative low albumin level,preoperative high blood glucose level,American College of Anes⁃thetists gradeⅣ,undergoing vascular surgery,undergoing abdominal surgery,longer surgery duration,more surgery blood loss were risk factors for increased AKI after major non⁃cardiac surgery(P<0.05),while statin use was a protective factor for decreased AKI after major non⁃cardiac surgery(P<0.05).Conclusion AKI after major non⁃cardiac surgery is associated with advanced age,male,obesi⁃ty,heart failure,chronic kidney disease,use of angiotensin⁃converting enzyme inhibitors/angiotensin receptor blockers and calcium channel blockers,hypoalbumin,hyperglycemia,American College of Anesthesiologists classification,type of surgery,blood loss and duration of surgery.