基于RIFLF标准的中老年开腹手术后急性肾损伤危险因素分析

目的 分析外科相关急性肾损伤影响因素.方法 纳入2006年4月～ 2011年1月开腹手术合并术后急性肾损伤(AKI)患者46例,均符合RIFLF标准,记录患者各项临床资料.以同期开腹腔手术未合并AKI患者为对照,分析术后AKI患者发生的危险因素.通过生存曲线分析术后AKI病死率与AKI分期关系.结果 (1)纳入开腹手术合并AKI患者46例,平均年龄(52.56±8.28)岁,其中既往有肾脏病史患者9例.按RIFLF分期示AKI Ⅰ期患者24例；AKIⅡ期患者15例,AKIⅢ期患者7例；(2)单因素分析结果显示两组病例间术前肌酐、蛋白尿、营养不良、血容量不足、肾脏病史例数有显著性差异(P＜0.05)；(3)多因素分析结果显示急诊手术相对危险度(OR)为3.19,肾脏病史的OR为6.28；围手术期血容量不足OR为14.78；蛋白尿OR为2.21；术中失血超过1000 ml的OR为3.71,纳入方程有意义；(4)术后AKI生存曲线分析显示,AKI Ⅰ期、AKIⅡ、AKIⅢ期患者间病死率有显著性差异(P＜0.05).结论 外科开腹手术后AKI与多种因素相关,早期干预AKI发生是改善其预后的关键.

Risk factors of acute kidney injury in middle-aged and senile patients after laparotomy surgery based on RIFLF criteria

Objective To analyze the surgical factors affecting acute kidney injury.Methods Recording was made in the clinical data of 46 patients with postoperational acute kidney injury(AKI) after laparotomy from April 2006 to January 2011 according to RIFLF criteria.Patients receiving laparotomy at the same time but without AKI were selected as the control.The risk factors of patients with postoperative AKI were analyzed by single factor and multi-factor analysis methods.The relation between the mortality rate and the staging of AKI was analyzed by the survival curve after the operation.Results(1)Among the 46 patients receiving laparotomy and with postoperative AKI,the average age was(52.56 ± 8.28) years old,and 9 cases had renal disease history.According to the RIFLF staging,24 cases belonged to stage Ⅰ AKI,15 ones to stage Ⅱ AKI,and 7 ones to stage Ⅲ AKI.(2) The single factor analysis result showed that there were significant differences in the number of cases with preoperative creatinine,proteinuria,malnutrition,inadequate capacity,and the history of renal disease between the two groups(P<0.05).(3) The multi-factor analysis result showed that emergency surgery(OR: 3.19),the history of renal disease(OR: 6.28),perioperative inadequate capacity(OR: 14.78),proteinuria(OR: 2.21),and intraoperative blood loss exceeding 1000 ml(OR: 3.71) were risk factors.(4) The postoperative survival curve analysis showed that there were significant differences in the case fatality among patients with stageⅠ,Ⅱand Ⅲ AKI(P<0.05).Conclusion AKI after laparotomy has correlation with many risk factors.Early intervention in the occurrence of AKI is the key to improve its prognosis.