目标导向液体治疗对老年患者长时间腹部手术后急性肾损伤的影响

Effect of goal-directed fluid therapy on postoperative acute kidney injury in elderly patients undergoing long-time abdominal surgery

目的评价目标导向液体治疗(GDFT)对老年患者长时间腹部手术后急性肾损伤(AKI)的影响。方法通过电子病历数据库检索2016年10月1日至2022年6月30日在山西省人民医院择期首次接受腹部手术的老年胃肠道肿瘤患者,性别不限,年龄≥65岁,手术时间≥8 h,ASA分级Ⅱ或Ⅲ级。根据术中是否采用GDFT分为常规液体治疗组(C组)和GDFT组(G组)。C组术中维持BP≥90/60 mmHg或MAP≥65 mmHg,尿量≥30 ml/h。G组维持SVV≤13%、CI≥2.5 L·min^(-1)·m^(-2)。记录患者一般资料、术中液体使用量、尿量、出血量、血管活性药物使用情况、腹腔热灌注情况和手术时间;记录术后72 h内AKI及术后其他并发症(肺炎、吻合口瘘、手术部位感染、感染性休克、心律失常)的发生情况,记录术后住院时间以及术后30 d死亡情况。结果共纳入125例患者,C组41例,G组84例。19例患者发生术后AKI,发生率为15.2%。与C组比较,G组术中晶体液用量、总输液量、尿量减少,血管活性药物使用率增加(P<0.05),术后AKI发生风险降低(OR=0.23,P<0.05),术后其他并发症发生率、30 d病死率及住院时间差异无统计学意义(P>0.05)。结论 GDFT可降低老年患者长时间腹部手术后AKI的发生风险。

Objective To evaluate the effect of goal-directed fluid therapy(GDFT)on postoperative acute kidney injury(AKI)in elderly patients undergoing long-time abdominal surgery.Methods The medical records from elderly patients of both sexes,aged≥65 yr,with a duration of operation≥8 h and American Society of Anesthesiologists Physical Status classificationⅡorⅢ,undergoing elective first abdominal surgery for gastrointestinal tumors at the Shanxi Provincial People′s Hospital from October 1,2016 to June 30,2022,were collected from the electronic medical record database.Patients were divided into conventional fluid therapy group(group C)and GDFT group(group G)according to whether GDFT was employed during operation.In group C,blood pressure was maintained≥90/60 mmHg or mean arterial pressure≥65 mmHg,and urine output more than 30 ml/h.In group G,the stroke volume variation was maintained≤13%,and cardiac index≥2.5 L·min^(-1)·m^(-2).The patient general characteristics,requirement for fluid,urine output,blood loss,requirement for vasoactive agents and abdominal hyperthermic perfusion,and operation time were recorded during operation.The development of AKI within 72 h after operation and development of other complications(pneumonia,anastomotic leakage,surgical site infection,septic shock,arrhythmia)after operation were recorded.The length of hospital stay and 30-day mortality after operation were recorded.Results A total of 125 patients were included in this study,with 41 patients in group C and 84 patients in group G.Postoperative AKI occurred in 19 patients,with an incidence of 15.2%.Compared with group C,the requirement for colloid,total volume of fluid infused and urine volume were significantly decreased during operation,the requirement for vasoactive agents was increased during operation(P<0.05),the risk of postoperative AKI was reduced(OR=0.23,P<0.05),and no significant change was found in the incidence of other postoperative complications,30-day mortality,and length of hospital stay in group G(P>0.05).Conclusions GDFT can reduce the risk of AKI in the elderly patients undergoing long-time abdominal surgery.