PDF(Pubmed)
Abstract：
Acute kidney injury (AKI) prevalence in surgical patients is high, emphasizing the need for preventative measures. This study addresses the insufficient evidence on nephroprotective intraoperative fluid resuscitation and highlights the drawbacks of relying solely on serum creatinine/urine output to monitor kidney function. This study assessed the impact of intraoperative fluid management on AKI in female breast cancer patients undergoing autologous breast reconstruction, utilizing novel urinary biomarkers (TIMP-2 and IGFBP-7). In a monocentric prospective randomized controlled trial involving 40 patients, liberal (LFA) and restrictive (FRV) fluid management strategies were compared. TIMP-2 and IGFBP-7 biomarker levels were assessed using the NephroCheck (bioMerieux, France) test kit at preoperative, immediate postoperative, and 24-h postoperative stages. FRV showed significantly higher immediate postoperative biomarker levels, indicating renal tubular stress. FRV patients had 21% (4/19) experiencing AKI compared to 13% (2/15) in the LFA group according to KDIGO criteria (p = 0.385). Restrictive fluid resuscitation increases the risk of AKI in surgical patients significantly, emphasizing the necessity for individualized hemodynamic management. The findings underscore the importance of urinary biomarkers in early AKI detection.
摘要：
手术患者急性肾损伤(AKI)患病率高,强调需要采取预防措施。这项研究解决了肾保护性术中液体复苏的证据不足，并强调了仅依靠血清肌酐/尿量监测肾功能的缺点。这项研究评估了术中液体管理对接受自体乳房重建的女性乳腺癌患者AKI的影响。利用新的尿液生物标志物（TIMP-2和IGFBP-7）。在一项涉及40名患者的单中心前瞻性随机对照试验中，比较了自由（LFA）和限制性（FRV）液体管理策略。使用NephroCheck（bioMerieux，法国)术前检测试剂盒，术后即刻,术后24小时。FRV显示术后即刻生物标志物水平显著较高，表明肾小管应力。根据KDIGO标准，FRV患者有21%(4/19)经历AKI，而LFA组为13%(2/15)(p=0.385)。限制性液体复苏显著增加手术患者发生AKI的风险,强调个体化血流动力学管理的必要性。这些发现强调了尿生物标志物在早期AKI检测中的重要性。
