术前血清氯化物水平与非心脏手术后死亡率和发病率的相关性：回顾性队列研究
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Association of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery: A Retrospective Cohort Study
背景与目的
已知术后高氯血症与手术后死亡率和发病率的增加有关。然而，术前高氯血症和低氯血症与术后死亡率和发病率的关系尚不清楚。我们的目的是用术前血清氯化物试验进行评估术前高氯血症或低氯血症与非心脏手术后90天死亡率和发病率之间的关系。
方 法
在这项回顾性队列研究中，我们回顾了2010年1月至2016年12月接受非心脏手术的20岁以上患者的医疗记录。根据手术前1个月内进行的血清氯化物检测结果将患者分组：正常氯血症，97-110mmol·L−1；高氯血症 >110 mmol·L−1，低氯血症<97 mmol·L−1。本研究的主要终点是术前各血清氯化物组术后90天死亡率的差异。次要终点是术前各血清氯化物组术后急性肾损伤发生率的差异。
结 果
最后，共有106505名病人被包括在内(2147被分配至术前低氯血症组及617名被分配至高氯血症组)。多变量Cox回归分析显示，与正常组相比，低氯血症(危害比, 1.46; 95% CI, 1.16–1.84; P = .001)和高氯血症组 (危害比, 1.76; 95%CI, 1.13–2.73; P = .013)的90天死亡率显著增加。此外，多变量logistic回归分析显示，与正常氯血症组相比，术前低氯血症组急性肾损伤的几率增加了1.83倍（odds ratio，1.83；95%，1.53–2.19；p.001）。
结 论
术前低氯血症和高氯血症与非心脏手术后90天死亡率升高有关。此外，术前低氯血症与术后急性肾损伤的风险增加有关。
原始文献摘要
Tak Kyu Oh, MD, Sang-Hwan Do, MD, PhD, Young-Tae Jeon, MD, PhD,Jinhee Kim, MD, PhD,Hyo-Seok Na, MD, PhD,and Jung-Won Hwang, MD, PhD.Association of Preoperative Serum Chloride Levels With Mortality and Morbidity After Noncardiac Surgery: A Retrospective Cohort Study.Anesth Analg 2019;129:1494–501.
BACKGROUND: Postoperative hyperchloremia is known to be related to increases in mortality and morbidity after surgery. However, the relationship between preoperative hyperchloremia and hypochloremia and postoperative mortality and morbidity is not well established. Our aim was to evaluate the relationship between preoperative hyperchloremia or hypochloremia, as assessed using preoperative serum chloride tests, and 90-day mortality and morbidity after noncardiac surgery.
METHODS: In this retrospective cohort study, we reviewed the medical records of patients >20 years of age who underwent noncardiac surgery between January 2010 and December 2016.Patients were categorized into one of the following groups on the basis of the results of serumchloride testing performed within 1 month before surgery: normochloremia, 97–110 mmol·L−1;hyperchloremia, >110 mmol·L−1; and hypochloremia, <97 mmol·L−1. The primary end point of this study was the difference in postoperative 90-day mortality among the preoperative serum chloride groups. The secondary end point was the difference in postoperative acute kidneyinjury incidence among the preoperative serum chloride groups.
RESULTS: A total of 106,505 patients were included in the final analysis (2147 were allocated to the preoperative hypochloremia group and 617 to the hyperchloremia group). Multivariable Cox regression analysis revealed significantly increased 90-day mortality in the hypochloremia(hazard ratio, 1.46; 95% CI, 1.16–1.84; P = .001) and hyperchloremia (hazard ratio, 1.76; 95%CI, 1.13–2.73; P = .013) groups when compared with the normochloremia group. In addition,multivariable logistic regression analysis revealed a 1.83-fold increased odds of acute kidney injury in the preoperative hypochloremia group when compared with the normochloremia group(odds ratio, 1.83; 95% CI, 1.53–2.19; P < .001).
CONCLUSIONS: Preoperative hypochloremia and hyperchloremia were related to increased 90-day mortality after noncardiac surgery. In addition, preoperative hypochloremia was related to an increased risk for postoperative acute kidney injury.
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翻译：任文鑫 编辑：何幼芹 审校：王贵龙