背景:胰腺手术与急性肾损伤(AKI)和临床相关的术后胰瘘(CR-POPF)的显著风险相关。这项研究评估了术中容量给药的影响,血管加压药治疗,和对胰腺手术后AKI的主要结局和CR-POPF的次要结局的血压管理。
方法:这项回顾性单中心队列研究了200例连续胰腺手术(2018年1月至2021年12月)。根据AKI(肾脏疾病改善全球结果)和CR-POPF的存在/不存在对患者进行分类。单因素分析后,我们构建了多变量模型来控制主要和次要结局的单变量辅助因子差异.
结果:在人口统计学(体重指数和性别)上有显著单变量差异的20例患者(10%)中发现了AKI,合并症,慢性肾功能不全的指标,和AKI风险评分增加。手术特点,术中液体,血管加压药,有和无AKI患者的血压管理相似.AKI患者失血增加,降低尿量,和包装红细胞管理。经过多变量分析,男性(OR=7.9,95%C.I.1.8-35.1)和AKI风险评分(OR=6.3,95%C.I.2.4-16.4)与AKI的发展相关(p<0.001)。术中和术后容量,血管加压药给药,在多变量分析中,术中低血压没有显著影响.在多变量分析中,有23例(11.9%)患者发生CR-POPF,无明显影响因素。发生AKI或CR-POPF的患者手术并发症增加,逗留时间,出院到熟练的护理机构,和死亡率。
结论:在此分析中,术中容量给药,血管加压药治疗,血压<55mmHg超过10分钟与AKI风险增加无关。经过多变量分析,男性和AKI风险评分升高与AKI发生可能性增加相关.
BACKGROUND: Pancreatic surgery is associated with a significant risk for acute kidney injury (AKI) and clinically relevant postoperative pancreatic fistula (CR-POPF). This investigation evaluated the impact of intraoperative volume administration, vasopressor therapy, and blood pressure management on the primary outcome of AKI and the secondary outcome of a CR-POPF after pancreatic surgery.
METHODS: This retrospective single-center cohort investigated 200 consecutive pancreatic surgeries (January 2018-December 2021). Patients were categorized for the presence/absence of AKI (Kidney Disease Improving Global Outcomes) and CR-POPF. After univariate analysis, multivariable models were constructed to control for the univariate cofactor differences in the primary and secondary outcomes.
RESULTS: AKI was identified in 20 patients (10%) with significant univariate differences in demographics (body mass index and gender), comorbidities, indices of chronic renal insufficiency, and an increased AKI Risk score. Surgical characteristics, intraoperative fluid, vasopressor, and blood pressure management were similar in patients with and without AKI. Patients with AKI had increased blood loss, lower urine output, and packed red blood cell administration. After multivariate analysis, male gender (OR = 7.9, 95% C.I. 1.8-35.1) and the AKI Risk score (OR = 6.3, 95% C.I. 2.4-16.4) were associated with the development of AKI (p < 0.001). Intraoperative and postoperative volume, vasopressor administration, and intraoperative hypotension had no significant impact in the multivariate analysis. CR-POPF occurred in 23 patients (11.9%) with no significant contributing factors in the multivariate analysis. Patients who developed AKI or a CR-POPF had an increase in surgical complications, length of stay, discharge to a skilled nursing facility, and mortality.
CONCLUSIONS: In this analysis, intraoperative volume administration, vasopressor therapy, and a blood pressure < 55 mmHg for more than 10 min were not associated with an increased risk of AKI. After multivariate analysis, male gender and an elevated AKI Risk score were associated with an increased likelihood of AKI.