摘要
目的探讨结直肠癌患者围术期尿液浓缩对血肌酐(Scr)水平的影响。方法收集2018年8月9日至2019年11月28日于静脉吸入复合全身麻醉下行结直肠癌根治手术患者共126例[其中树兰(杭州)医院66例,绍兴市人民医院60例]。分别于术前(麻醉诱导后)、术后[离开麻醉复苏室(PACU)时]以及术后第1天采集尿液10 ml,测定尿比重、尿肌酐(Ucr)、尿渗透压和尿色评分,计算液体潴留指数(FRI);记录术前1 d和术后第1天血生化和血常规检测结果并作分析比较。结果与术前相比,术后和术后第1天的FRI值均显著升高(均P<0.01),术前FRI值与术后FRI/术前FRI呈负相关(r=-0.86,P<0.01)。ROC曲线分析表明,术前Ucr截断值为8.5 mmol/L时预测Scr升高,AUC为0.57(P<0.05);术后第1天Ucr截断值为9.2 mmol/L时预测Scr升高,AUC为0.64(P<0.01);而术后第1天FRI截断值为4.0时预测Scr升高,AUC为0.64(P<0.01)。根据术后第1天Scr较术前升高或降低分成升高组和降低组,与降低组比较,升高组术后第1天Ucr[8.5(6.2,9.9)mmol/L比7.2(5.1,9.1)mmol/L]和FRI(3.7±1.0比3.4±1.0)均升高(均P<0.05)。结论结肠直肠手术启动尿液浓缩,并持续到术后第1天。围术期尿液浓缩可以预测术后Scr升高。
Objective To explore the effect of perioperative urine concentration on serum creatinine(Scr)level in patients with colorectal cancer.Methods FromAugust 2018 to November 2019,126 ASA I-II patients with colorectal cancer undergoing selective radical operation under combined intravenous with inhalation general anesthesia in Shulan(Hangzhou)Hospital(n=66)and Shaoxing People's Hospital were enrolled(n=60).Urine samples were collected before and after operation,and 1 day after operation.Urine specific gravity,urine creatinine(Ucr),osmotic pressure and color specific score were measured,and fluid retension index(FRI)was calculated to evaluate the urine concentration.The blood biochemical indexes and postoperative outcome indexes were recorded 1 day before and 1 day after operation.Results Compared with preoperative value,the FRI after operation and 1 day postoperative was significantly increased(both P<0.01).The preoperative FRI was negatively correlated with FRIpost/FRIpre(r=-0.86,P<0.01).ROC curve analysis showed that the AUC of preoperative Ucr for predicting the increase of Scr was 0.57(P<0.05),and the cutoff value was 8.5 mmol/L,the AUC of Ucr at one day after operation for predicting the increase of Scr was 0.64(P<0.01)and the cutoff value was 9.2 mmol/L.The AUC of FRI at one day after operation for predicting the increase of Scr was 0.64(P<0.01),and the cutoff value was 4.0.Compared with preoperative value,patients with increased Scr 1 day after operation had higher Ucr[8.5(6.2,9.9)mmol/L vs.7.2(5.1,9.1)mmol/L,P<0.01]and FRI(3.7±1.0 vs.3.4±1.0,P<0.01)than those with decreased Scr.Conclusion Colorectal surgery initiates the urine concentration and extends to 1 day postoperative.Perioperative urine concentration can predict the increase of postoperative Scr level.
作者
黄则勇
何锐
胡双燕
卢清旺
黄素琴
赵娴
李玉红
HUANG Zeyong;HE Rui;HU Shuangyan;LU Qingwang;HUANG Suqin;ZHAO Xian;LI Yuhong(Department of Anesthesiology,Shulan(Hangzhou)Hospital,Hangzhou 310004,China)
出处
《浙江医学》
CAS
2021年第23期2551-2555,2560,共6页
Zhejiang Medical Journal
基金
浙江省科学技术厅公益项目(LGF19H030011、LY21H150001)
浙江省医药卫生科技计划项目(2020KY329)
绍兴市公益项目(2020A13014)
浙江省医学会临床科研资金项目(2018ZYC-A46)。
关键词
血肌酐
尿肌酐
急性肾损伤
尿液浓缩
液体潴留指数
Serumcreatinine
Urine creatinine
Acute kidney injury
Urine concentration
Fluid retension index
