术中少尿可预测腹部手术后急性肾损伤的发生
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Intraoperative oliguria predicts acute kidney injury after major abdominal surgery
背景与目的
术中尿量阈值与急性肾损伤（AKI）的发生风险增加尚不清楚。本研究主要探讨腹部大手术患者术中尿量与术后AKI之间的关系，从而明确AKI发生风险增加时的尿量阈值。
方 法
对在京都大学附属医院接受腹部手术（肝，结直肠，胃，胰或食管切除）的3560例患者的围手术期资料进行回顾性分析。本研究评估了术中尿量和术后AKI的发生之间的关系。进行Logistic回归分析以分析相关变量，并使用P值法，最终确定从AKI发生风险增加时尿量的阈值。
结 果
本研究中AKI发生率为6.3%；使用最小P值法，可确定尿量最小阈值为0.3 ml∕kg∕h，低于此阈值AKI发生风险增加（校正比=2.65；95%CI：1.77～3.69；P﹤0.001）；此模型与传统的AKI评分标准比较无明显差异（95%CI:0.049～0.270;P=0.05）
结 论
在接受腹部大手术的患者中，术中尿<0.3ml∕kg∕h 时，术后AKI发生风险增加。
原始文献摘要
T. Mizota, Y. Yamamoto, M. Hamada, S. Matsukawa, S. Shimizu and S. Kai; Intraoperative oliguria predicts acute kidney injury after major abdominal surgery; British Journal of Anaesthesia, 119 (6): 1127–34 (2017)
Background: The threshold of intraoperative urine output below which the risk of acute kidney injury (AKI) increases is unclear. The aim of this retrospective cohort study was to investigate the relationship between intraoperative urine output during major abdominal surgery and the development of postoperative AKI and to identify an optimal threshold for predicting the differential risk of AKI.
Methods: Perioperative data were collected retrospectively on 3560 patients undergoing major abdominal surgery (liver, colorectal,gastric, pancreatic, or oesophageal resection) at Kyoto University Hospital. We evaluated the relationship between intraoperative urine output and the development of postoperative AKI as defined by recent guidelines. Logistic regression analysis was performed to adjust for patient and operative variables, and the minimum P-value approach was used to determine the threshold of intraoperative urine output that independently altered the risk of AKI.
Results: The overall incidence of AKI in the study population
was 6.3%. Using the minimum P-value approach, a threshold of 0.3ml∕kg∕h was identified, below which there was an increased risk of AKI (adjusted odds ratio, 2.65; 95% confidence interval, 1.77－3.97; P<0.001). The addition of oliguria <0.3ml∕kg∕h to a model with conventional risk factors significantly improved risk stratification for AKI (net reclassification improvement, 0.159; 95% confidence interval,0.049–0.270; P=0.005).
Conclusions: Among patients undergoing major abdominal surgery, intraoperative oliguria <0.3ml∕kg∕h was significantly associated with increased risk of postoperative AKI.
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