ScvO_(2)对老年患者机器人辅助肾部分切除术后急性肾损伤的预测价值

Predictive value of ScvO_(2)for acute kidney injury after robot-assisted partial nephrectomy in elderly patients

目的探究中心静脉血氧饱和度(ScvO_(2))对老年患者机器人辅助肾部分切除(RAPN)术后急性肾损伤(AKI)的预测价值。方法回顾性收集2022年2-9月在解放军总医院第三医学中心泌尿外科接受RAPN的78例老年患者的临床资料。依据国际肾病改善全球预后标准诊断AKI,根据术后是否发生AKI将患者分为AKI组(n=22)与非AKI组(n=56)。分别于中心静脉穿刺置管后(T_(0))、肾动脉阻断5 min后(T_(1))、肾动脉开放5 min后(T_(2))、手术结束后(T_(3))抽取动、静脉血进行血气分析,分别记录血红蛋白(Hb)、动脉血乳酸(Lac)、动脉血氧分压(PaO_(2))、ScvO_(2),计算氧摄取率(O_(2)ER)。采用多因素logistic回归分析术后AKI的危险因素,采用受试者工作特征(ROC)曲线分析ScvO_(2)对老年患者RAPN术后AKI的预测价值。结果与非AKI组比较,AKI组T_(1)-T_(2)时空腹血糖(FPG)水平均明显增高(P<0.05)。与T_(0)时比较,两组T_(1)-T_(3)时FPG水平明显升高(P<0.01);与T_(1)时比较,非AKI组T_(3)时FPG水平明显升高(P<0.01)。与非AKI组比较,AKI组T_(1)-T_(2)时ScvO_(2)明显升高(P<0.01),T_(2)时Lac水平明显升高(P<0.05)。各时间点两组间O_(2)ER比较差异均无统计学意义(P>0.05)。与T_(0)时比较,两组T_(1)-T_(3)时O_(2)ER均明显下降(P<0.01),ScvO_(2)均明显升高(P<0.01);与T_(1)时比较,非AKI组T_(2)-T_(3)时ScvO_(2)明显升高(P<0.05或P<0.01);与T_(2)时比较,非AKI组T_(3)时ScvO_(2)明显升高(P<0.05)。多因素分析结果显示,T_(1)ScvO_(2)(OR=1.127,95%CI 1.006~1.263,P=0.039)为RAPN术后AKI的独立危险因素。ROC曲线分析结果显示,T_(1)ScvO_(2)预测RAPN术后AKI的敏感度为77.3%,特异度为71.4%,截断值为81%,曲线下面积(AUC)为0.761。结论ScvO_(2)对于RAPN术后短期内AKI的发生具有一定的预测价值。

Objective To investigate the predictive value of central venous oxygen saturation(ScvO_(2))in elderly patients with acute kidney injury(AKI)after robot-assisted partial nephrectomy(RAPN).Methods Seventy-eight elderly patients who underwent RAPN in the Department of Urology,the Third Medical Center of Chinese PLA General Hospital from February to September 2022 were selected.AKI was diagnosed according to the International Nephropathy Improving Global Prognosis Criteria,and the patients were divided into AKI group(n=22)and non-AKI group(n=56)according to whether AKI occurred after surgery.Blood gas analysis of venous blood was taken after central venous puncture(T_(0)),5 min after renal artery occlusion(T_(1)),5 min after renal artery opening(T_(2)),and after surgery(T_(3)).Hemoglobin(Hb),arterial blood lactic acid(Lac),arterial oxygen partial pressure(PaO_(2)),ScvO_(2)were recorded respectively.Oxygen uptake rate(O_(2)ER)were calculated.Multivariate logistic regression analysis was used to analyze the risk factors for postoperative AKI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of ScvO_(2)for AKI in elderly patients after RAPN.Results Compared with non-AKI group,fasting plasma glucose(FPG)level in AKI group significantly increased at T_(1)-T_(2)(P<0.05).Compared with T_(0),FPG level in two groups obviously increased at T_(1)-T_(3)(P<0.01).Compared with T_(1),the FPG level in T_(3) significantly increased in non-AKI group(P<0.01).Compared with non AKI group,ScvO_(2)in AKI group significantly increased at T_(1)-T_(2)(P<0.01),Lac level at T_(2) significantly increased(P<0.05).There was no significant difference in O_(2)ER between the two groups at each time point(P>0.05).Compared with T_(0),O_(2)ER in T_(1)-T_(3) significantly decreased(P<0.01),and ScvO_(2)in both groups significantly increased(P<0.01).Compared with T_(1),ScvO_(2)in non-AKI group significantly increased at T_(2)-T_(3)(P<0.05 or P<0.01).Compared with T_(2),ScvO_(2)in non-AKI group significantly increased in T_(3)(P<0.05).Multiple-factor analysis showed that T_(1)ScvO_(2)(OR=1.127,95%CI 1.006-1.263,P=0.039)was an independent risk factor for AKI after RAPN.ROC curve analysis showed that T_(1)ScvO_(2)had a sensitivity of 77.3%,specificity of 71.4%,truncation value of 81%,and area under the curve(AUC)of 0.761 in predicting AKI after RAPN.Conclusion ScvO_(2)has certain predictive value for the occurrence of short-term AKI after RAPN.