达芬奇机器人辅助肾部分切除术后急性肾损伤风险预测模型构建及预防策略研究

Construction of acute kidney injury risk prediction model and prevention strategies after Da Vinci robot-assisted partial nephrectomy

目的:构建使用第4代达芬奇Xi机器人手术系统行机器人辅助肾部分切除术(RAPN)后发生急性肾损伤(AKI)的风险预测模型,并分析预防策略。方法:回顾性收集2023年5月—2024年1月收治的86例接受达芬奇Xi手术系统辅助RAPN的肾癌患者临床资料。根据术后是否发生AKI将患者分为AKI组(n=16)和非AKI组(n=70)。比较两组患者基线资料及围手术期指标,采用二元Logistic回归分析检验达芬奇Xi手术系统辅助RAPN后肾癌患者AKI的影响因素并构建列线图模型进行内部验证。结果:高血压、糖尿病、体重指数、术后肺炎、热缺血时间是影响接受达芬奇Xi手术系统辅助RAPN肾癌患者术后AKI的危险因素,24 h内每5 min RR间期均值标准差(SDANN)是保护因素;C-index值为0.957,模型具有良好区分度,ROC结果显示列线图模型预测达芬奇Xi手术系统辅助RAPN术后肾癌患者AKI的AUC为0.987,具有一定预测价值;特异度、敏感度、约登指数分别0.952、0.970、0.922。结论:高血压、糖尿病、体重指数、术后肺炎、热缺血时间及SDANN是达芬奇Xi机器人手术系统辅助RAPN肾癌患者术后发生AKI相关的独立影响因素。

Objective:To construct a risk prediction model for acute kidney injury(AKI)after Da Vinci Xi robotassisted partial nephrectomy(RAPN)and to explore related prevention strategies.Methods:Clinical data of 86 renal cancer patients who underwent RAPN in the First Affiliated Hospital of Xinjiang Medical University from May 2023 to January 2024 were retrospectively collected.Patients were divided into the AKI group(n=16)and non-AKI group(n=70)according to whether AKI occurred after surgery.General data and perioperative indicators of patients in the two groups were compared,and binary Logistic regression analysis was used to analyze the influencing factors for AKI after RAPN,and a Nomogram model was created for internal validation.Results:Hypertension,diabetes mellitus,body mass index(BMI),postoperative pneumonia,and warm ischemia time were risk factors affecting postoperative AKI in renal cancer patients who underwent RAPN,and standard deviation of the 5-minute average NN intervals(SDANN)was a protective factor.The C-index value was 0.957,and the model had good discrimination.The ROC results showed that the Nomograph model predicted AKI in renal cancer patients after RAPN with an AUC of 0.987,which has certain predictive value.The specificity,sensitivity,and Youden index were 0.952,0.970,and 0.922,respectively.Conclusion:Hypertension,diabetes mellitus,BMI,postoperative pneumonia,warm ischemia time and SDANN are independent influencing factors associated with the occurrence of AKI in renal cancer patients underwent RAPN.