术中低血压对膀胱切除术患者术后早期急性肾损伤的影响：一项回顾性队列分析
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术中低血压对膀胱切除术患者术后早期急性肾损伤的影响：一项回顾性队列分析
翻译：吴学艳 编辑：冯玉蓉 审校：曹莹
研究目的：评估接受泌尿外科大手术患者术中低于固定阈值的不同低血压分界对术后急性肾损伤(AKI)的危险性。我们假设低血压低于一定血压阈值的持续时间是泌尿外科大手术中发生AKI的危险因素。
试验设计：回顾性观察队列研究。
机构：单个三级高病例量医学中心。
受试人群：2013年至2019年期间连续416例接受开放根治性膀胱切除术、盆腔淋巴结清扫和尿道重建术的患者。
干预措施：无。
方法：我们根据AKIN（Acute Kidney Injury Network）诊断标准的术中数据分析了低血压阈值及其与术后AKI的相关性：将患者分为MAP<65 mmHg组、MAP<60 mmHg组和MAP<55 mmHg组。使用logistic回归法计算所有危险变量以及低血压阈值变量(低于某一阈值的分钟数)得出术后发生AKI的概率。
主要结果：128/416例（30.8%）患者术后被诊断为AKI。多因素Logistic回归分析显示：血压阈值低于65 mmHg(OR 1.010[1.005~1.015]，P < 0.001)和低于60 mmHg(OR 1.012[1.001~1.023]，P = 0.02）与AKI风险增加有关。平均而言，在麻醉诱导和手术开始的这段时间内，MAP<65 mmHg、MAP<60 mmHg和MAP<55 mmHg的发生率分别为26.5%、50%和76.5%。因此低血压的发生完全归因于麻醉管理。
结论：我们的研究结果表明，术中MAP应避免＜65mmHg，特别是避免＜60mmHg，可保护膀胱切除术患者术后肾功能。应特别注意从麻醉诱导到手术切皮时的这段时间，此期间易发生低血压。
原始文献来源：Löffel LM, Bachmann KF, Furrer MA, et al. Impact of intraoperative hypotension on early postoperative acute kidney injury in cystectomy patients – A retrospective cohort analysis[J].J Clin Anesth 2020 Jun 29;66.
Impact of intraoperative hypotension on early postoperative acute kidney injury in cystectomy patients – A retrospective cohort analysis
Abstract
Study objective: To assess the risk for postoperative acute kidney injury (AKI) after major urologic surgery fordifferent intraoperative hypotension thresholds in form of time below a fixed threshold. We hypothesize that the duration of hypotension below a certain hypotension threshold is a risk factor for AKI also in major urologic procedures.
Design: Retrospective observational cohort series.
Setting: Single tertiary high caseload center.
Patients: 416 consecutive patients undergoing open radical cystectomy, pelvic lymph node dissection and ur-inary diversion between 2013 and 2019.
Interventions: None.
Measurements: We analyzed intraoperative data and their correlation to postoperative AKI judged according tothe Acute Kidney Injury Network criteria. Patients were divided into groups falling below MAP< 65 mmHg,MAP <60 mmHg and MAP <55 mmHg. The probability of developing postoperative AKI using all risk variables as well as the hypotension threshold variables (minutes under a certain threshold) was calculated using logistic regression methods.
Main results: Postoperative AKI was diagnosed in 128/416 patients (30.8%). Multiple logistic regression analysis showed that minutes below a threshold of 65mmHg (OR 1.010 [1.005–1.015], P < 0.001) and 60mmHg (OR1.012 [1.001–1.023], P= 0.02) are associated with an increased risk of AKI. On average, 26.5%(MAP< 65mmHg), 50.0% (MAP< 60mmHg) and 76.5% (MAP<55 mmHg) of minutes below a certain threshold occurred between induction of anesthesia and start of surgery and are thus fully attributable to an-esthesiological management.
Conclusions: Our results suggest that avoiding intraoperative MAP lower than 65mmHg and especially lower than 60 mmHg will protect postoperative renal function in cystectomy patients. The time between induction of anesthesia and surgical incision warrants special attention as a relevant share of hypotension occur in this period.
贵州医科大学高鸿教授课题组
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