急性肾损伤(AKI)是手术后常见的并发症,手术越复杂,风险越大。手术期间,患者暴露于多种因素的组合,这些因素均与AKI的发生有关.这些包括低血压和低血容量,脓毒症,全身性炎症,使用肾毒性剂,组织损伤,输注血液或血液制品,缺血,氧化应激和再灌注损伤。考虑到AKI的风险,早期发现有AKI风险的患者将转化为获益,这似乎是合乎逻辑的.AKI的常规标志物,即血清肌酐和尿量是定义慢性肾脏疾病的主要因素,但不太适合急性期。这种担忧在手术患者中变得更加复杂,因为他们的活动能力通常会大大降低。营养水平欠佳,肌肉体积减少。由于积极的液体复苏,许多患者也可能有误导性的低血清肌酐和高尿量,特别是在重症监护病房。在过去的二十年里,关于AKI的所谓“新型”生物标志物的表现,已经积累了相当多的信息,在这里,我们讨论了手术环境中检查最多的分子和性能。我们还讨论了生物标志物在指导患者术后护理中的应用。
大手术后肾脏损伤很常见,最近的一项研究表明,几乎每5名患者中就有1名患有肾脏损伤。用于测量肾功能的常规测试在门诊患者中非常出色,但在急性情况下却不太好。因此,人们对新的肾损伤标志物(所谓的新型生物标志物)产生了极大的兴趣,这些标志物表现良好,可以更早地检测到损伤,从而可以更早地开始治疗.本文总结了目前可用于术后使用的生物标志物,并指出了通过常规使用它们可以获得的不同信息。
Acute kidney injury (AKI) is a common complication after surgery and the more complex the surgery, the greater the risk. During surgery, patients are exposed to a combination of factors all of which are associated with the development of AKI. These include hypotension and hypovolaemia, sepsis, systemic inflammation, the use of nephrotoxic agents, tissue injury, the infusion of blood or blood products, ischaemia, oxidative stress and reperfusion injury. Given the risks of AKI, it would seem logical to conclude that early identification of patients at risk of AKI would translate into benefit. The conventional markers of AKI, namely serum creatinine and urine output are the mainstay of defining chronic kidney disease but are less suited to the acute phase. Such concerns are compounded in surgical patients given they often have significantly reduced mobility, suboptimal levels of nutrition and reduced muscle bulk. Many patients may also have misleadingly low serum creatinine and high urine output due to aggressive fluid resuscitation, particularly in intensive care units. Over the last two decades, considerable information has accrued with regard to the performance of what was termed \"novel\" biomarkers of AKI, and here, we discuss the most examined molecules and performance in surgical settings. We also discuss the application of biomarkers to guide patients\' postoperative care.
Kidney damage is common after major surgery with a recent study showing almost 1 in 5 patients suffer kidney damage. The usual tests for measuring kidney function are excellent in the outpatient but not so good in acute scenario’s. Therefore, there has been a lot of interest in new markers of kidney damage (so-called novel biomarkers) which perform well acutely and allow earlier detection of damage allowing treatment to be started earlier. This article summarises the currently available biomarkers for use post-operatively and points out the different information that can be achieved by using them routinely.