文章摘要
肝切除术中肾脏局部氧饱和度与术后急性肾损伤的相关性
Correlation between regional kidney oxygen saturation and postoperative acute kidney injury during liver resection surgery
  
DOI：10.12089/jca.2023.09.006
中文关键词: 急性肾损伤  肝切除  肾脏局部氧饱和度  相关性
英文关键词: Acute kidney injury  Liver resection  Regional kidney oxygen saturation  Correlation
基金项目:国家重点研发课题（2018YFC2001901）；北京市科技新星计划（Z211100002121171）
作者单位E-mail
刘畅 100853,北京市,解放军总医院第一医学中心麻醉科  
李皓 100853,北京市,解放军总医院第一医学中心麻醉科  
于瑶 100853,北京市,解放军总医院第一医学中心麻醉科  
时文珠 100853,北京市,解放军总医院第一医学中心麻醉科  
孙景佳 100853,北京市,解放军总医院第一医学中心麻醉科  
沙小玲 100853,北京市,解放军总医院第一医学中心麻醉科  
姚四一 100853,北京市,解放军总医院第一医学中心麻醉科  
李昭 100853,北京市,解放军总医院第一医学中心麻醉科  
米卫东 100853,北京市,解放军总医院第一医学中心麻醉科 wwdd1962@aliyun.com 
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中文摘要:
      
目的 应用近红外光谱技术（NIRS）监测肝切除术中肾脏局部氧饱和度（rSKO2）的变化，评估其与术后急性肾损伤（AKI）的相关性。
方法 选择2020年9月至2021年10月择期在全麻下行开腹肝切除术的患者99例，男77例，女22例，年龄60～80岁，BMI 18～30 kg/m2，ASA Ⅱ或Ⅲ级。根据改善全球肾脏病预后（KDIGO）标准判断术后7 d内是否发生AKI，并将患者分为两组：AKI组和非AKI组。记录基础值（T0）、麻醉诱导即刻（T1）、手术开始即刻（T2）、肝门阻断即刻（T3）、肝门阻断后5 min（T4）、10 min（T5）、肝门开放即刻（T6）、肝门开放后10 min（T7）、20 min（T8）、30 min（T9）、手术结束时（T10）的rSKO2。记录肝门阻断时间、液体输注量、出血量等术中情况。采用单因素和多因素Logistic回归分析术中rSKO2与AKI的相关性。
结果 术后7 d内有16例（16%）患者发生AKI。与AKI组比较，非AKI组T1、T3—T7、T9、T10时rSKO2水平明显升高（P＜0.05）。术中rSKO2绝对值低于70%（OR=3.87，95%CI 1.17~15.37，P＜0.05）或下降幅度大于基础值的20%（OR=4.96，95%CI 1.53~18.66，P＜0.05）与术后AKI发生呈正相关。
结论 术中rSKO2下降与术后AKI发生呈正相关，NIRS监测rSKO2可以较好地反映患者术中肾脏氧供需状态。
英文摘要:
      
Objective To investigate the correlation between regional kidney oxygen saturation (rSKO2) monitoring by near infrared spectroscopy (NIRS) and postoperative acute kidney injury (AKI) during liver resection surgery.
Methods Ninety-nine patients underwent elective open liver resection with general anesthesia from September 2020 to October 2021 were selected, 77 males and 22 females, aged 60-80 years, BMI 18-30 kg/m2, ASA physical status Ⅱ or Ⅲ. Intraoperative rSKO2 was continuously monitored by NIRS, and rSKO2 values at different time points were recorded: baseline (T0), beginning of anesthesia induction (T1), beginning of surgery (T2), hepatic portal clamping (T3), 5 minutes after hepatic portal clamping (T4), 10 minutes after hepatic portal clamping (T5), hepatic portal release (T6), 10 minutes after hepatic portal release (T7), 20 minutes after hepatic portal release (T8), 30 minutes after hepatic portal release (T9), and the end of surgery (T10). According to the kidney disease improving global outcomes (KDIGO) criteria, the occurrence of AKI was identified, and the patients were divided into in two groups: the AKI group and the non-AKI group. Intraoperative hepatic portal clamping duration, fluid infusion volume and blood loss were also recorded. Univariate and multivariate logistic analysis was conducted to identify the correlation between intraoperative rSKO2 and AKI.
Results Sixteen patients (16%) suffered AKI within 7 days after surgery. Compared with the AKI group, rSKO2 in the non-AKI group was significantly increased at T1, T3-T7, T9, T10 (P < 0.05). Intraoperative rSKO2 under 70% (OR = 3.87, 95% CI 1.17-15.37, P < 0.05) level or with a desaturation exceeding 20% (OR = 4.96, 95% CI 1.53-18.66, P < 0.05) were shown to be positive correlation with the occurrence of postoperative AKI.
Conclusion Intraoperative decline of rSKO2 is positive correlation with postoperative AKI, and NIRS monitoring of rSKO2 can better reflect the balance of renal perfusion and oxygen supply and demand.
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