个性化血压管理策略对老年胃肠手术后急性肾损伤的影响

黄金; 刘训芹; 李昂庆; 程岑; 刘学胜; 顾尔伟

doi:10.16766/j.cnki.issn.1674-4152.002532

个性化血压管理策略对老年胃肠手术后急性肾损伤的影响

doi: 10.16766/j.cnki.issn.1674-4152.002532

1.
安徽医科大学第一附属医院麻醉科，安徽合肥 230022
2.
安徽医科大学第一附属医院胃肠外科，安徽合肥 230022

基金项目:

安徽省重点研究和开发计划项目 1804h08020267

详细信息

通讯作者:
顾尔伟, E-mail: ay_guew_mz@163.com

中图分类号: R619 R692
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出版历程
- 收稿日期: 2021-10-24
- 网络出版日期: 2022-09-23

Influence of individualised blood pressure management strategy on postoperative acute kidney injury in the elderly patients who underwent gastrointestinal surgery

1.
Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨个性化血压管理策略对老年胃肠手术后急性肾损伤的影响，以期为降低急性肾损伤发生率提供一定的临床数据。方法选择2018年9月—2019年12月安徽医科大学第一附属医院择期行胃肠手术的患者166例，采用随机数字表法随机分为个性化血压管理策略组(IM组，84例)与标准血压管理策略组(CON组，82例)。比较2组患者各时点平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、肌酐(CRE)、血尿素氮(BUN)和估算肾小球滤过率(eGFR)以及急性肾损伤(AKI)的发生率。结果 2组患者一般资料比较差异无统计学意义(均P＞0.05)。手术麻醉过程中，2组MAP(气管插管前至术毕)、SBP(气管插管前至术毕)、DBP(切皮后1 h)比较差异有统计学意义(|t|＞2.330，均P＜0.05)。2组患者CRE均随时间改变，差异有统计学意义(F=188.547，P＜0.001)。2组BUN随时间无明显改变，差异无统计学意义(F=1.919，P=0.125)。2组eGFR术后较术前均上升，但组间差异无统计学意义(F=1.121，P=0.291)。IM组发生AKI 3例(3.6%)，CON组发生AKI共10例(12.2%)，2组AKI的发生率差异有统计学意义(χ²=4.275，P=0.039)。结论采用个性化血压管理策略有助于降低老年胃肠手术后急性肾损伤的发生率。
- 术中低血压 /
- 老年 /
- 急性肾损伤 /
- 个性化血压管理策略
Abstract: Objective To explore the effect of individualised blood pressure management strategy on postoperative acute kidney injury (AKI) in elderly patients who underwent gastrointestinal surgery to provide certain clinical data for reducing the incidence of AKI. Methods A total of 166 patients who underwent elective gastrointestinal surgery in the First Affiliated Hospital of Anhui Medical University from September 2018 to December 2019 were selected. The patients were randomly divided into individualised blood pressure management group (IM group, n=84) and standard blood pressure management strategy group (CON group, n=82). The mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine (CRE), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR) and incidence of AKI (acute kidney injury) were observed at each time point in the two groups. Results No statistically significant difference was found in the general data between the two groups (P > 0.05).During the operation, two groups of the MAP, SBP (before endotracheal intubation to at the end of the operation) and DBP (one hour after the operation)comparative difference was statistically significant (|t| > 2.330, all P < 0.05). The levels of serum creatinine in both groups changed with time and the difference was statistically significant (F=188.547, P < 0.001). The values of BUN did not significantly change with time but with statistical difference between the two groups (F=1.919, P=0.125).The postoperative value of eGFR increased in both groups compared with the preoperative value but no statistical difference was observed (F=1.121, P=0.291).However, a statistical difference was found in the number of AKI between the two groups [3(3.6%) vs. 10(12.2%), χ²=4.275, P=0.039]. Conclusion Individualised blood pressure management strategy is helpful to reduce the incidence of AKI after gastrointestinal surgery in the elderly.
- Intraoperative hypotension /
- Elderly /
- Acute kidney injury /
- Individualised blood pressure management strategy

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表 1 2组择期行胃肠手术患者一般资料比较

Table 1. Comparison of general data of patients undergoing gastrointestinal surgery between the two groups

项目	IM组(n=84)	CON组(n=82)	统计量	P值
年龄(x±s, 岁)	70.6±6.7	69.1±6.0	1.542^a	0.125
性别(女/男, 例)	24/60	14/68	3.108^b	0.078
体重(x±s, kg)	60.1±9.8	60.3±9.2	-0.117^a	0.907
身高(x±s, cm)	163.9±7.0	164.0±7.4	-0.117^a	0.907
BMI(x±s)	22.3±2.9	22.4±2.8	-0.152^a	0.879
吸烟(是/否, 例)	23/61	26/56	0.373^b	0.541
饮酒(是/否, 例)	21/63	32/50	3.755^b	0.053
高血压(是/否, 例)	38/46	40/42	0.209^b	0.648
糖尿病(例)	4	4	0.001^b	0.972
冠心病(例)	5	5	0.002^b	0.969
脑梗死个人史(例)	9	5	1.145^b	0.285
肺部疾病(例)	3	2	0.182^b	0.670
CCI(x±s)	2.9±0.8	2.8±0.9	0.382^a	0.703
ASA分级(Ⅰ/Ⅱ/Ⅲ, 例)	18/52/14	15/52/15	0.283^b	0.868
心功能分级(Ⅰ/Ⅱ/Ⅲ, 例)	54/29/1	44/38/0	3.597^b	0.166
手术类别(胃/肠, 例)	61/23	62/20	0.193^b	0.660
手术方式(腹腔镜/开放, 例)	6/78	5/77	0.073^b	0.787
注：^a为t值，^b为χ²值。CCI为查尔森合并症指数(Charlson comorbidity index)。

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表 2 2组择期行胃肠手术患者术中麻醉管理比较(x±s)

Table 2. Comparison of intraoperative anesthesia management undergoing gastrointestinal surgery between the two groups(x±s)

组别	例数	手术时间(min)	晶体液总量(mL)	胶体液总量(mL)	总液体量(mL)	术中尿量(mL)
IM组	84	122.8±33.6	402.4±109.2	422.0±90.0	824.4±168.7	246.4±145.8
CON组	82	122.8±39.9	925.0±252.8	853.7±276.6	1571.3±334.8	228.7±126.9
t值		0.001	-17.219	-13.452	-18.084	0.837
P值		0.999	＜0.001	＜0.001	＜0.001	0.404

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表 3 2组择期行胃肠手术患者各时间点血压比较(x±s, mm Hg)

Table 3. Comparison of blood pressure at each time point undergoing gastrointestinal surgery between the two groups(x±s, mm Hg)

组别	例数	MAP
组别	例数	T0	T1	T2	T3	T4	T5	T6
IM组	84	94.3±10.1	88.6±8.2^a	87.8±7.6^a	91.3±6.5	91.0±6.8^b	91.1±7.5^b	91.3±7.2^b
CON组	82	95.8±8.5	80.3±10.9^a	81.7±10.8^a	84.0±11.0^a	84.5±10.6^a	82.5±11.2^a	83.8±10.3^a
t值		-1.090	5.505	4.167	5.164	4.619	5.754	5.420
P值		0.277	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	SBP
组别	例数	T0	T1	T2	T3	T4	T5	T6
IM组	84	148.3±17.2	146.1±14.7	144.7±14.6	152.1±13.3^b	150.3±15.8	151.0±16.3	150.9±16.2
CON组	82	149.6±15.7	123.3±19.3^a	127.5±20.1^a	133.8±22.4^ac	133.8±22.2^ac	129.3±21.9^a	130.9±22.4^a
t值		-0.489	8.566	6.331	6.377	5.498	7.251	6.577
P值		0.626	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	DBP
组别	例数	T0	T1	T2	T3	T4	T5	T6
IM组	84	65.3±7.2	60.7±6.1^a	60.3±5.8^a	61.7±5.3^a	61.8±4.4^a	62.1±4.8^a	61.5±4.0^a
CON组	82	66.8±5.8	59.4±7.6^a	59.9±7.4^a	60.2±7.1^a	60.4±5.9^a	60.1±6.1^a	60.2±5.5^a
t值		-1.470	1.209	0.383	1.519	1.720	2.330	1.680
P值		0.143	0.229	0.702	0.131	0.087	0.021	0.095
注：与T0比较，^aP＜0.05；与T2比较，^bP＜0.05；与T1比较，^cP＜0.05。

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表 4 2组择期行胃肠手术患者各时间点肾功能指标比较(x±s)

Table 4. Comparison of renal function indexes undergoing gastrointestinal surgery between the two groups at each time point(x±s)

组别	例数	CRE(μmol/L)
组别	例数	术前	术后第1天	术后第2天	术后第5天
IM组	84	75.5±15.4	68.1±14.6^a	64.4±13.3^a	63.3±12.5^a
CON组	82	77.4±14.5	71.8±14.0	72.7±16.5	71.2±15.9^a
t值		-0.829	-1.668	-3.568	-3.585
P值		0.409	0.097	＜0.001	＜0.001

组别	例数	BUN(mmol/L)
组别	例数	术前	术后第1天	术后第2天	术后第5天
IM组	84	5.7±1.5	5.7±1.4	5.6±1.4	5.9±1.4
CON组	82	5.4±1.5	6.0±2.0	5.8±2.4	5.5±2.2
t值		1.195	-1.408	-0.894	1.360
P值		0.234	0.159	0.373	0.176

组别	例数	eGFR[mL/(min·1.73 m²)]
组别	例数	术前	术后第1天	术后第2天	术后第5天
IM组	84	87.7±13.2	95.3±10.9^a	96.6±12.2^a	98.6±10.0^a
CON组	82	87.8±13.8	92.8±12.5^a	95.7±11.6^a	96.4±10.8^a
t值		-0.027	1.361	0.437	1.368
P值		0.979	0.175	0.663	0.173
注：与术前比较，^aP＜0.05。

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