重症监护中高危手术后的术后少尿，一项队列分析。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-11-21 DOI:10.1016/j.jcrc.2024.154976

Rodolpho Augusto de Moura Pedro , Guilherme Bittar Cunha , Igor Pietrobom , Bruna Carla Scharanch , Daniel Caraca Cubos , Rafael Alves Franco , Fernando Zampieri , Thiago Gomes Romano

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引用次数: 0

摘要

导言：少尿通常被用作急性肾损伤（AKI）的临界值，但尿量减少在手术过程中很常见，可能是围手术期的一种适应性反应，而不是肾小球滤过率的降低，从而可能导致术后 AKI 发生率被高估。尽管这一难题已在术中得到解决，但术后第一天少尿的发生率和影响仍是目前文献中的空白。我们的主要目标是描述与术后少尿相关的发生率、风险因素和临床结果：这是一项回顾性队列研究，在巴西两家私立医院的四个重症监护病房（ICU）进行，分析了2018年1月1日至2022年12月31日期间中高危手术后入院的患者：最终分析共纳入了 1476 名患者。其中 656 人（44.5%）为男性，年龄中位数为 61.7 岁。508名患者（34.4%）在术后24小时内出现少尿症状。入院时需要使用血管加压药、非选择性手术、男性和基线血清肌酐在少尿患者中的比例较高。在少尿患者中，出现 AKI 的患者年龄和基础血清肌酸酐较高。虽然根据血清肌酐标准，只有 12.4% 的少尿患者发生了 AKI，但这一发生率明显高于非少尿患者组（3.6%），RR 为 3.42，IC 95 % 为 2.3-5.1（p 结论：少尿患者中，年龄和基础血清肌酐较低的患者发生 AKI 的比例较高：术后少尿在中高风险外科手术后很常见，会增加发生 AKI 的风险。然而，少尿在很大程度上与以血清肌酐测量的肾功能失调无关（87.6%），这让人怀疑利尿是否会高估术后 AKI 的发生率。

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Postoperative oliguria after intermediate and high-risk surgeries in critical care, A cohort analysis

Introduction

Oliguria is commonly used as a cutoff for acute kidney injury (AKI), however, a decrease in urine output is common during surgery and may represent an adaptative response in the perioperative setting rather than a reduction in glomerular filtration rate, leading to a possible overestimation of postoperative AKI incidence. Although this dilemma has been addressed in the intraoperative scenario, the incidence and impact of oliguria in the first postoperative day represents a gap in the current literature. Our main goal is to describe the incidence, risk factors and clinical outcomes related to postoperative oliguria.

Methods

This was a retrospective cohort conducted in four intensive care units (ICUs) across two private Brazilian hospitals, analyzing patients admitted after intermediate and high-risk surgeries between January 1, 2018 and December 31, 2022.

Results

1476 patients were included in the final analysis. Overall, 656 (44,5 %) were males, and the median age was 61,7 years. Oliguria was identified in 508 (34,4 %) patients within the first 24 h after surgery. Vasopressor requirement at admission, non-elective procedures, male sex and baseline serum creatinine were higher among oliguric patients. Among oliguric patients, age and basal serum creatine were higher among those who experienced AKI. Although only 12,4 % of oliguric patients developed AKI according to serum creatinine criterion, this incidence was significantly higher than in non-oliguric group (3,6 %), RR 3.42, IC 95 % 2.3–5.1 (p < 0.01). AKI recovery, RRT, ICU and hospital free days, and mortality were similar between the groups.

Conclusions

Postoperative oliguria is common after intermediate and high-risk surgical procedures and increases the risk of AKI. However, oliguria was largely unrelated with kidney disfunction measured by serum creatinine (87,6 %), raising doubts on whether diuresis overestimates AKI incidence in the postoperative setting.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.