老年腰椎椎管狭窄症患者术后急性肾损伤的发生率及危险因素

目的探讨老年腰椎椎管狭窄症患者行经腰椎后路椎板切除椎间融合术后急性肾损伤(AKI)的发生率和危险因素。方法回顾性分析2017年6月-2019年6月因腰椎椎管狭窄症在本院接受后路腰椎椎板切除椎间融合术的老年(≥65岁)患者的临床资料,统计术后AKI的发生率。比较发生AKI的患者和未发生AKI的患者一般资料及术中资料,并采用单因素及多因素logistic回归模型分析术后发生AKI的危险因素。结果共纳入216例患者,其中男104例(48.15%)、女112例(51.85%),年龄65~76(69.32±3.58)岁。发生AKI 22例(10.19%),未发生AKI 194例(89.81%)。与未发生AKI的患者相比,发生AKI患者的年龄较大、术前血红蛋白和基础估计的肾小球滤过率(eGFR)较低、麻醉时间较长、术中尿量较少、术中出血量较多。单因素logistic回归分析显示,年龄、基础eGFR水平、术前血红蛋白水平、麻醉时间、术中尿量、术中出血量均为术后发生AKI的危险因素;多因素logistic回归分析显示,基础eGFR水平和术中尿量是术后发生AKI的独立危险因素。结论AKI是老年腰椎椎管狭窄症患者术后常见并发症,基础eGFR水平和术中尿量是术后发生AKI的独立危险因素。

Incidence and risk factors of acute kidney injury in elderly patients with lumbar spinal stenosis after operation

Objective To investigate the incidence and risk factors of acute kidney injury(AKI)in elderly patients with lumbar spinal stenosis after posterior lumbar laminectomy and interbody fusion.Methods Clinical data of elderly patients(≥65 yearsold)admitted to Central Hospital of Bazhong City who underwent posterior lumbar laminectomy and interbody fusion due to lumbar spinal stenosis from June 2017 to June 2019 were retrospectively analyzed.The AKI incidence rate was calculated.The general data and intraoperative data were compared between patients with AKI and patients without AKI,and the risk factors of postoperative AKI were analyzed by univariate and multivariate logistic regression analyse.Results A total of 216 patients were recruited in the study.There were 104 males(48.15%)and 112 females(51.85%)whom aged 65-76(69.32±3.58)years.Twenty-two(10.19%)patients developed AKI and 194(89.81%)patients did not develop AKI.Compared with the patients without AKI,patients with AKI were older,had lower preoperative hemoglobin and basal estimated glomerular filtration rate(eGFR),longer anesthesia time,less intraoperative urine volume and more intraoperative blood loss.Univariate logistic regression analysis revealed that age,basal eGFR level,preoperative hemoglobin level,anesthesia time,intraoperative urine volume and intraoperative blood loss were all significantly associated with AKI.Multivariate logistic regression analysis manifested that the basal eGFR level and intraoperative urine volume were independent risk factors for AKI.Conclusion AKI is a common complication in elderly patients with lumbar spinal stenosis after operation.Basal eGFR level and urine volume during the operation are independent risk factors for AKI after the operation.