摘要
目的探讨术前肾功能正常的成年脊柱结核患者行椎体结核病灶清除术后发生急性肾功能损伤(acute kidney injury,AKI)的危险因素。方法采用回顾性病例对照研究方法,搜集2009~2018年首都医科大学附属北京胸科医院收治的年龄>18岁、术前肾功能正常,且行脊柱结核手术(后路病灶清除+椎间植骨融合+内固定术)治疗的成人脊柱结核患者2535例,参照排除标准最终纳人2068例。依据全球改善肾脏病预后组织(kidney disease improving global outcomes,KDIGO)指南,最终以术后发生AKI的31例患者作为并发AKI组,以未发生AKI的62例患者(与AKI组按1:2匹配同期、同手术部位及同手术方式的患者)作为对照组。采用单因素和多因素logistic回归分析两组患者的临床资料[年龄、性别、体质量指数(BMI),术前高血压、糖尿病、心脏病、吸烟史、慢性阻塞性肺疾病(COPD)、抗结核药物治疗时间、血肌酐(Scr)、尿素氮(BUN)血红蛋白(Hb).尿酸、白蛋白、C-反应蛋白(CRP)、估算的肾小球滤过率(eGFR),以及术中ASA分级、麻醉方式、有无高血压、有无低血压、手术时间、术中用药、胶体量、氯化钠注射液补液量、输血量、失血量、尿量,术后肺部感染、住院时间、院内死亡例数]与术后发生AKI的相关性。结果单因素分析结果显示,并发AKI组患者年龄≥60岁[64.52%(20/31)]、BMI>25[58.06%(18/31)]、术前高血压病史[54.84%(17/31)]高尿酸血症[87.10%(27/31)]、贫血[54.84%(17/31)]、术中失血量≥600 ml[64.52%(20/31)]等方面明显高于对照组[分别为41.94%(26/62)30.65%(19/62)29.03%(18/62)67.74%(42/62)19.35%(12/62)35.48%(22/62)](χ2值分别为4.216、5.864、6.486、4.043、12.126、7.034,P值分别为0.040、0.011、0.015、0.044、0.001、0.008);而术前eGFR290 ml.min^-1.(1.73 m^2)1[67.74%(21/31)]、术中使用右美托咪定[41.94%(13/31)]明显低于对照组[分别为87.10%(54/62)、64.52%(40/62)](χ2值分别为4.960、4.299,P值分别为0.026、0.038)。多因素logistic回归分析结果显示,术前BMI>25[Waldχ2=4.916,P=0.027,OR(95%CI):4.391(1.187~16.238)]、高尿酸血症[Waldχ2=4.412,P=0.036,OR(95%CI):5.896(1.126~30.874)]、贫血[Waldχ2=9.396,P=0.002,OR(95%CI):8.173(2.133~31.314)]、eGFR290 ml·min^-1(1.73m^2)-[Waldχ2=4.283,P=0.039,OR(95%CI):0.213(0.049~0.921)]是术后发生AKI的影响因素。结论术前肾功能正常的脊柱结核患者行椎体结核病灶清除术,术前BM>25、并发高尿酸血症和贫血是术后发生AKI的危险因素,而术前高eGFR水平是保护性因素。
Objective To explore risk factors of acute kidney injury(AKI)after surgical treatment in adult spinal tuberculosis patients whose preoperative renal function were normal.Methods A retrospective study was conducted in spinal tuberculosis patients undergoing debridement surgery(posterior debridement and interbody fusion with intermal fixation)in Beijing Chest Hospital Attached to Capital Medical University from 2009 to 2018,all the patients aged≥18 years and their preoperative renal function were normal.According to exclusion criteria,2068 of 2535 spinal tuberculosis patients were enrolled.Based on the inclusion criteria and guidelines of kidney disease improving global outcomes(KDIGO),31 cases with AKI after surgery were selected as AKI group,and 62 cases with the same surgical treatment were control group.Data including age,gender,body mass index(BMI),preoperative hypertension,diabetes,heart disease,smoking history,chronic obstructive pulmonary disease(COPD),anti-tuberculosis drug treatment time,serum creatinine(Scr),blood urea nitrogen(BUN),hemoglobin(Hb),uric acid,albumin,C-reactive protein(CRP),estimated glomerular filtration rate(eGFR),ASA classification,anesthesia,hypertension,hypotension,surgical duration,intraoperative medication,Hydroxyethyl starch 130/0.4 sodium chloride injection,fuid volume,blood transfusion,blood loss,urine,postoperative pulmonary infection,postoperative hospital stay,number of deaths in the hospital,were analyzed using multivariate logistic regression,in order to explore the relationship of them and postoperative AKI.Results Univariate analysis showed that the preoperative age≥60 years old(64.52%(20/31)vs.41.94%(26/62),χ2=4.216,P=0.040),BMI>25(58.06%(18/31)vs.30.65%(19/62),χ2=6.486,P=0.011),history of hypertension(54.84%(17/31)vs.29.03%(18/62),χ2=5.864,P=0.015),hyperuricemia(87.10%(27/31)vs.67.74%(42/62),χ2=4.043,P=0.044),anemia(54.84%(17/31)vs.19.35%(12/62),χ2=12.126,P=0.001),and intraoperative blood loss≥600 ml(64.52%(20/31)vs.35.48%(12/62),χ2=7.034,P-0.008)were in AKI group significantly higher than those in the control group;while preoperative eGFR≥90 ml·min^-1.(1.73 m^2)^-1(67.74%(21/31)vs.87.10%(54/62),χ2=4.960,P-0.026)and intraoperative dexmedetomidine(41.94%(13/31)vs.64.52%(40/62),χ2=4.299,P=0.038)were signifcantly lower than those in the control group.According to multivariate logistic regression analysis,BMI>25(Waldχ2=4.916,P=0.027,OR(95%CN):4.391(1.182-16.238)),hyperuricemia(Waldχ2=4.412,P=0.036,OR(95%C):5.896(1.126-30.874)),eGFR>90 ml·min^-1(1.73 m^2)^-1(Waldχ2=4.283,P=0.039,OR(95%CD):0.213(0.049-0.921)),and anemia(Waldχ2=9.396,P=0.002,OR(95%CI):8.173(2.133-31.314))before surgery were risk factors for postoperative AKI.Conclusion For postoperative AKI in the spinal tuberculosis patients with normal preoperative renal function,BMI>25 and preoperative hyperuricemia and anemia are risk factors;while preoperative high eGFR are protective factors.
作者
李坤
罗太君
王菲
贾红彦
张宗德
刘伟
Li Kun;Luo Taijun;Wang Fei;Jia Hongyan;Zhang Zongde;Liu Wei(Department of Anesthesiology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)
出处
《结核病与胸部肿瘤》
2020年第1期35-44,共10页
Tuberculosis and Thoracic Tumor
基金
“十二五”国家科技重大专项(2015ZX10004801-003)
“十三五”国家科技重大专项(2017ZX10201301-004)
北京市医管局登峰人才计划(DFL20181601)。
关键词
结核
脊柱
外科手术
手术后并发症
急性肾功能不全
因素分析
统计学
Tuberculosis,spinal
Surgical procedures,operative
Postoperative complications
Acute kidney injury
Factor analysis,statistical
