文章摘要
ASA Ⅰ或Ⅱ级患者全膝关节置换术后急性肾损伤的危险因素
Risk factors of acute kidney injury after primary total knee arthroplasty in patients with ASA physical status Ⅰ or Ⅱ
  
DOI：10.12089/jca.2023.12.011
中文关键词: 急性肾损伤  全膝关节置换术  慢性肾脏疾病  ASA分级
英文关键词: Acute kidney injury  Primary total knee arthroplasty  Perioperative transfusion  American Society of Anesthesiologists physical status
基金项目:北京协和医院中央高水平医院临床科研专项青年培优计划（2022-PUMCH-A-062）
作者单位E-mail
徐慧 100730,中国医学科学院,北京协和医学院,北京协和医院麻醉科  
马璐璐 100730,中国医学科学院,北京协和医学院,北京协和医院麻醉科 malulu@pumch.cn 
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中文摘要:
      
目的 探讨ASA Ⅰ或Ⅱ级患者全膝关节置换术后急性肾损伤（AKI）的危险因素。
方法 回顾性分析2014年1月至2019年12月初次行全膝关节置换术的患者2 623例，男513例，女2 110例，年龄≥18岁，ASA Ⅰ或Ⅱ级。收集人口学信息、围术期资料和术后AKI的发生情况。按照改善全球肾脏病预后组织标准（KDIGO），根据术后48 h内是否发生AKI将患者分为两组：AKI组和非AKI组。采用二元Logistic回归分析ASA Ⅰ或Ⅱ级患者全膝关节置换术后AKI的独立危险因素。
结果 有51例（1.9%）患者发生术后AKI。二元Logistic回归分析显示，围术期输血（OR=3.979，95%CI 2.243～7.056，P<0.001）、手术时间延长（OR=1.007，95%CI 1.001～1.013，P=0.031）和围术期复合应用抗生素（万古霉素+头孢呋辛/克林霉素）（OR=4.053，95%CI 1.350～12.165，P=0.013）是术后急性肾损伤的独立危险因素。
结论 围术期输血、手术时间延长和复合应用抗生素（万古霉素+头孢呋辛/克林霉素）是ASA Ⅰ或Ⅱ级患者全膝关节置换术后AKI的危险因素。
英文摘要:
      
Objective To determine the incidence of acute kidney injury in patients undergoing primary total knee arthroplasty with ASA physical status Ⅰ or Ⅱ.
Methods odsA total of 2 623 patients from January 2014 to December 2019, 513 males and 2 110 females, aged ≥ 18 years, ASA physical status Ⅰ or Ⅱ, who underwent primary total knee arthroplasty were included. Demographic characteristics and perioperative data were collected. AKI was diagnosed according to the criteria from Kidney Disease Improving Global Outcomes (KDIGO) and the patients were divided into two groups: AKI group and non-AKI group. Independent risk factors of acute kidney injury were evaluated by binary logistic regression.
Results Forty-one patients (1.9%) developed acute kidney injury postoperatively. Binary logistic regression showed perioperative transfusion (OR = 3.979, 95% CI 2.243-7.056, P < 0.001), the duration of operation (OR = 1.007, 95% CI 1.001-1.013, P = 0.031) and perioperative combined use of antibiotics (vancomycin + cefuroxime/clindamycin) (OR = 4.053, 95% CI 1.350-12.165, P = 0.013) were independent predictive factors of acute kidney injury.
Conclusion Perioperative transfusion, longer duration of operation, and combined use of antibiotics (vancomycin + cefuroxime／clindamycin) were risk factors for postoperative AKI in patients with ASA physical status Ⅰ or Ⅱ．
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