孟昭婷;穆东亮;

• 1:北京大学第一医院麻醉科

摘要(Abstract)：

目的:探索术中尿量对术后急性肾损伤(acute kidney injury,AKI)的影响,以及术后AKI发生的独立危险因素。方法:选择2017年7月至2019年6月于北京大学第一医院在全身麻醉下接受择期肺叶切除术的患者作为研究对象进行回顾性队列研究。将入组患者按照是否发生术后AKI分为AKI组和对照组。首先对围术期各变量进行单因素分析,探讨其与术后AKI的关系;其次,采用受试者工作特征曲线(receiver operating characteristic curve,ROC curve)分析术中尿量对术后AKI的预测价值,并以约登(Youden)指数为最大值时的上下4个界值[以0.1mL/(kg·h)为间隔]为少尿界值,采用单因素分析探索各界值定义下的少尿与AKI发生风险的关系,并取OR值最大者为少尿界值;最后,将单因素分析中P <0.10的围术期各变量共同代入多因素Logistic回归模型,分析术后AKI的独立危险因素。结果:共1 393名患者最终纳入研究,术后AKI发生率为2.2%。ROC曲线显示术中单位尿量用于预测术后AKI的曲线下面积为0.636(P=0.009),约登指数为最大值时(约登指数0.234,敏感度48.4%,特异度75.0%)的少尿界值为0.785 mL/(kg·h)。进一步取0.7、0.8、0.9、1.0 mL/(kg·h)以及传统界值0.5mL/(kg·h)为少尿界值分析少尿对术后AKI的影响。单因素分析显示,以小于0.8 mL/(kg·h)为少尿界值时,少尿患者发生AKI的风险增加最为显著(OR=2.774,95%CI 1.357～5.671,P=0.004)。多因素回归分析显示术中尿量<0.8 mL/(kg·h)(OR=2.698,95%CI 1.260～5.778,P=0.011)是术后AKI发生的独立危险因素,另两个独立危险因素为术前血红蛋白≤120.0 g/L(OR=3.605,95%CI 1.545～8.412,P=0.003)以及术前估计肾小球滤过率<30 mL/(min·1.73 m~2)(OR=11.009,95%CI 1.813～66.843,P=0.009)。结论:对于肺叶切除术,术中少尿是术后AKI发生的独立危险因素,且尿量<0.8 mL/(kg·h)是可能的筛选标准。

关键词(KeyWords)： 肺外科手术;少尿症;急性肾损伤;排尿量;危险因素

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目(2018YFC2001800)~~

作者(Author): 孟昭婷;穆东亮;

Email:

DOI: 10.19723/j.issn.1671-167X.2021.01.028

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