肝切除术中肾脏局部氧饱和度与术后急性肾损伤的相关性

Correlation between regional kidney oxygen saturation and postoperative acute kidney injury during liver resection surgery

目的应用近红外光谱技术(NIRS)监测肝切除术中肾脏局部氧饱和度(rSkO_(2))的变化,评估其与术后急性肾损伤(AKI)的相关性。方法选择2020年9月至2021年10月择期在全麻下行开腹肝切除术的患者99例,男77例,女22例,年龄60~80岁,BMI 18~30 kg/m^(2),ASAⅡ或Ⅲ级。根据改善全球肾脏病预后(KDIGO)标准判断术后7 d内是否发生AKI,并将患者分为两组:AKI组和非AKI组。记录基础值(T_(0))、麻醉诱导即刻(T_(1))、手术开始即刻(T_(2))、肝门阻断即刻(T_(3))、肝门阻断后5 min(T_(4))、10 min(T_(5))、肝门开放即刻(T_(6))、肝门开放后10 min(T_(7))、20 min(T_(8))、30 min(T_(9))、手术结束时(T_(10))的rSkO_(2)。记录肝门阻断时间、液体输注量、出血量等术中情况。采用单因素和多因素Logistic回归分析术中rSkO_(2)与AKI的相关性。结果术后7 d内有16例(16%)患者发生AKI。与AKI组比较,非AKI组T_(1)、T_(3)—T_(7)、T_(9)、T_(10)时rSkO_(2)水平明显升高(P<0.05)。术中rSkO_(2)绝对值低于70%(OR=3.87,95%CI 1.17~15.37,P<0.05)或下降幅度大于基础值的20%(OR=4.96,95%CI 1.53~18.66,P<0.05)与术后AKI发生呈正相关。结论术中rSkO_(2)下降与术后AKI发生呈正相关,NIRS监测rSkO_(2)可以较好地反映患者术中肾脏氧供需状态。

Objective To investigate the correlation between regional kidney oxygen saturation(rSkO_(2))monitoring by near infrared spectroscopy(NIRS)and postoperative acute kidney injury(AKI)during liver resection surgery.Methods Ninety-nine patients underwent elective open liver resection with general anesthesia from September 2020 to October 2021 were selected,77 males and 22 females,aged 60-80 years,BMI 18-30 kg/m^(2),ASA physical statusⅡorⅢ.Intraoperative rSkO_(2)was continuously monitored by NIRS,and rSkO_(2)values at different time points were recorded:baseline(T_(0)),beginning of anesthesia induction(T_(1)),beginning of surgery(T_(2)),hepatic portal clamping(T_(3)),5 minutes after hepatic portal clamping(T_(4)),10 minutes after hepatic portal clamping(T_(5)),hepatic portal release(T_(6)),10 minutes after hepatic portal release(T_(7)),20 minutes after hepatic portal release(T_(8)),30 minutes after hepatic portal release(T_(9)),and the end of surgery(T_(10)).According to the kidney disease improving global outcomes(KDIGO)criteria,the occurrence of AKI was identified,and the patients were divided into in two groups:the AKI group and the non-AKI group.Intraoperative hepatic portal clamping duration,fluid infusion volume and blood loss were also recorded.Univariate and multivariate logistic analysis was conducted to identify the correlation between intraoperative rSkO_(2)and AKI.Results Sixteen patients(16%)suffered AKI within 7 days after surgery.Compared with the AKI group,rSkO_(2)in the non-AKI group was significantly increased at T_(1),T_(3)-T_(7),T_(9),T_(10)(P<0.05).Intraoperative rSkO_(2)under 70%(OR=3.87,95%CI 1.17-15.37,P<0.05)level or with a desaturation exceeding 20%(OR=4.96,95%CI 1.53-18.66,P<0.05)were shown to be positive correlation with the occurrence of postoperative AKI.Conclusion Intraoperative decline of rSkO_(2)is positive correlation with postoperative AKI,and NIRS monitoring of rSkO_(2)can better reflect the balance of renal perfusion and oxygen supply and demand.