围手术期急性肾损伤的研究进展
|
摘要
急性肾损伤(AKI)是指数小时至数天内肾功能的突发持续下降的一种临床综合征,而外科手术是患者发生AKI的主要原因,AKI的出现会使得患者的病情加重和诊疗策略变得复杂化。有效降低患者围手术期急性肾损伤发生的风险是目前临床上迫切需要解决的难题。文章主要从围手术期肾损伤的概念、流行病学、病理生理学及肾损伤相关危险因素方面进行综述。
Acute Kidney Injury(AKI)is a clinical syndrome with a sudden decline in renal function in hours to days. Surgery is the main cause of AKI in patients. The presence of AKI can make patients worse and the diagnosis and treatment strategy complicated. Effectively reducing the risk of AKI in perioperative patients is an urgent problem to be solved. Therefore,this article elaborates on the concept of perioperative renal injury,epidemiology,pathophysiological mechanism and risk factors related to kidney injury,and provides some reference for clinicians to effectively avoid perioperative AKI occur.
Acute Kidney Injury(AKI)is a clinical syndrome with a sudden decline in renal function in hours to days. Surgery is the main cause of AKI in patients. The presence of AKI can make patients worse and the diagnosis and treatment strategy complicated. Effectively reducing the risk of AKI in perioperative patients is an urgent problem to be solved. Therefore,this article elaborates on the concept of perioperative renal injury,epidemiology,pathophysiological mechanism and risk factors related to kidney injury,and provides some reference for clinicians to effectively avoid perioperative AKI occur.
引文
[1] Tsai H,Tsai F,Chen Y,et al. Impact of Acute Kidney Injury on One-Year Survival After Surgery for Aortic Dissection[J].Ann Thorac Surg,2012,94(5):1407-1412.
[2] Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury[J]. Nephron Clin Pract,2012,120(4):C179-C184.
[3] Zhang Z. Biomarkers,diagnosis and management of sepsis-induced acute kidney injury:a narrative review[J]. Heart Lung Vessel,2015,7(1):64-73.
[4]江城,王凡,陈世伟,等.血中性粒细胞明胶酶相关脂质运载蛋白及胱抑素C对输尿管结石梗阻致急性肾损伤的早期诊断价值[J].东南国防医药,2018,20(3):240-243.
[5] O'Connor ME,Hewson RW,Kirwan CJ,et al. Acute kidney injury and mortality 1 year after major non-cardiac surgery[J]. Brit J Surg,2017,104(7):868-876.
[6]周收平,王昌兵,顾恒.急性肾损伤早期生物学标志物的研究现状[J].东南国防医药,2018,20(2):168-171.
[7] Weiser TG,Haynes AB,Molina G,et al. Estimate of the global volume of surgery in 2012:an assessment supporting improved health outcomes[J]. Lancet,2015,3852:11.
[8] Weiser TG,Regenbogen SE,Thompson KD,et al. An estimation of the global volume of surgery:a modelling strategy based on available data[J]. Lancet,2008,372(9633):139-144.
[9] O'Connor ME,Kirwan CJ,Pearse RM,et al. Incidence and associations of acute kidney injury after major abdominal surgery[J]. Intens Care Med,2016,42(4):521-530.
[10] Grams ME,Sang Y,Coresh J,et al. Candidate Surrogate End Points for ESRD after AKI[J]. J Am Soc Nephrol,2016,27(9):2851-2859.
[11] Hobson CE,Yavas S,Segal MS,et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery[J]. Circulation,2009,119(18):2444-2453.
[12] Grams ME,Sang Y,Coresh J,et al. Acute Kidney Injury After Major Surgery:A Retrospective Analysis of Veterans Health Administration Data[J]. Am J Kidney Dis,2016,67(6):872-880.
[13] Thiele RH,Isbell JM,Rosner MH. AKI Associated with Cardiac Surgery[J]. Clin J Am Soc Nephro,2015,10(3):500-514.
[14] O'Connor ME,Kirwan CJ,Pearse RM,et al. Incidence and associations of acute kidney injury after major abdominal surgery[J]. Intens Care Med,2016,42(4):521-530.
[15] Bertani T,Poggi A,Pozzoni R,et al. Adriamycin-induced nephrotic syndrome in rats:sequence of pathologic events[J]. Lab Invest,1982,46(1):16-23.
[16]孙涛,袁斌.益母草碱对多柔比星致小鼠肾损伤的保护作用[J].医学研究生学报,2018,31(12):1158-1162.
[17]王一鸣,张浩,杨志健,等.法舒地尔对造影剂诱导急性肾损伤的保护作用[J].医学研究生学报,2016,29(12):1270-1275.
[18] Kim M,Brady JE,Li G. Variations in the Risk of Acute Kidney Injury Across Intraabdominal Surgery Procedures[J]. Anesth Analg,2014,119(5):1121-1132.
[19] Prowle JR,Kam EPY,Ahmad T,et al. Preoperative renal dysfunction and mortality after non-cardiac surgery[J]. Brit J Surg,2016,103(10):1316-1325.
[20] Korenkevych D,Ozrazgat-Baslanti T,Thottakkara P,et al. The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery[J]. Ann Surg,2016,263(6):1219-1227.
[21] Kheterpal S,Tremper KK,Heung M,et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery:results from a national data set[J]. Anesthesiology,2009,110(3):505-515.
[22] Ko T,Higashitani M,Sato A,et al. Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection[J]. Am J Cardiol,2015,116(3):463-468.
[23]卢冬梅.非心脏手术围术期急性肾损伤研究进展[J].重庆医学,2018,47(10):1373-1375,1379.
[24]吴路加,罗林,童光,等. A型主动脉夹层术后肾脏功能损伤研究进展[J].中国循证心血管医学杂志,2018,10(3):366-369.
[25]叶永科.不同剂量右美托咪定对体外循环下心脏瓣膜置换手术患者血流动力学的影响[J].解放军医药杂志,2017,29(12):96-99.
[26] Sun LY,Wijeysundera DN,Tait GA,et al. Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery[J]. Anesthesiology, 2015,123(3):515-523.
[27] Salmasi V,Maheshwari K,Yang D,et al. Relationship between Intraoperative Hypotension,Defined by Either Reduction from Baseline or Absolute Thresholds,and Acute Kidney and Myocardial Injury after Noncardiac Surgery A Retrospective Cohort Analysis[J]. Anesthesiology,2017,126(1):47-65.
[28] Dellepiane S,Marengo M,Cantaluppi V. Detrimental cross-talk between sepsis and acute kidney injury:new pathogenic mechanisms,early biomarkers and targeted therapies[J]. Crit Care,2016,20:61.
[29] Zhang WR,Garg AX,Coca SG,et al. Plasma IL-6 and IL-10Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery[J]. J Am Soc Nephrol,2015,26(12):3123-3132.
[30] Lahiri R,Derwa Y,Bashir Z,et al. Systemic Inflammatory Response Syndrome After Major Abdominal Surgery Predicted by Early Upregulation of TLR4 and TLR5[J]. Ann Surg,2016,263(5):1028-1037.
[31] Jorgensen AL. Contrast-induced nephropathy:pathophysiology and preventive strategies[J]. Crit Care Nurse,2013,33(1):37-46.
[32] Etz CD,von Aspern K,Da Rocha E Silva J,et al. Impact of Perfusion Strategy on Outcome After Repair for Acute Type A Aortic Dissection[J]. Ann Thorac Surg,2014,97(1):78-86.
[33] Sasabuchi Y,Kimura N,Shiotsuka J,et al. Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair[J]. Ann Thorac Surg,2016,102(6):2003-2009.
[2] Khwaja A. KDIGO Clinical Practice Guidelines for Acute Kidney Injury[J]. Nephron Clin Pract,2012,120(4):C179-C184.
[3] Zhang Z. Biomarkers,diagnosis and management of sepsis-induced acute kidney injury:a narrative review[J]. Heart Lung Vessel,2015,7(1):64-73.
[4]江城,王凡,陈世伟,等.血中性粒细胞明胶酶相关脂质运载蛋白及胱抑素C对输尿管结石梗阻致急性肾损伤的早期诊断价值[J].东南国防医药,2018,20(3):240-243.
[5] O'Connor ME,Hewson RW,Kirwan CJ,et al. Acute kidney injury and mortality 1 year after major non-cardiac surgery[J]. Brit J Surg,2017,104(7):868-876.
[6]周收平,王昌兵,顾恒.急性肾损伤早期生物学标志物的研究现状[J].东南国防医药,2018,20(2):168-171.
[7] Weiser TG,Haynes AB,Molina G,et al. Estimate of the global volume of surgery in 2012:an assessment supporting improved health outcomes[J]. Lancet,2015,3852:11.
[8] Weiser TG,Regenbogen SE,Thompson KD,et al. An estimation of the global volume of surgery:a modelling strategy based on available data[J]. Lancet,2008,372(9633):139-144.
[9] O'Connor ME,Kirwan CJ,Pearse RM,et al. Incidence and associations of acute kidney injury after major abdominal surgery[J]. Intens Care Med,2016,42(4):521-530.
[10] Grams ME,Sang Y,Coresh J,et al. Candidate Surrogate End Points for ESRD after AKI[J]. J Am Soc Nephrol,2016,27(9):2851-2859.
[11] Hobson CE,Yavas S,Segal MS,et al. Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery[J]. Circulation,2009,119(18):2444-2453.
[12] Grams ME,Sang Y,Coresh J,et al. Acute Kidney Injury After Major Surgery:A Retrospective Analysis of Veterans Health Administration Data[J]. Am J Kidney Dis,2016,67(6):872-880.
[13] Thiele RH,Isbell JM,Rosner MH. AKI Associated with Cardiac Surgery[J]. Clin J Am Soc Nephro,2015,10(3):500-514.
[14] O'Connor ME,Kirwan CJ,Pearse RM,et al. Incidence and associations of acute kidney injury after major abdominal surgery[J]. Intens Care Med,2016,42(4):521-530.
[15] Bertani T,Poggi A,Pozzoni R,et al. Adriamycin-induced nephrotic syndrome in rats:sequence of pathologic events[J]. Lab Invest,1982,46(1):16-23.
[16]孙涛,袁斌.益母草碱对多柔比星致小鼠肾损伤的保护作用[J].医学研究生学报,2018,31(12):1158-1162.
[17]王一鸣,张浩,杨志健,等.法舒地尔对造影剂诱导急性肾损伤的保护作用[J].医学研究生学报,2016,29(12):1270-1275.
[18] Kim M,Brady JE,Li G. Variations in the Risk of Acute Kidney Injury Across Intraabdominal Surgery Procedures[J]. Anesth Analg,2014,119(5):1121-1132.
[19] Prowle JR,Kam EPY,Ahmad T,et al. Preoperative renal dysfunction and mortality after non-cardiac surgery[J]. Brit J Surg,2016,103(10):1316-1325.
[20] Korenkevych D,Ozrazgat-Baslanti T,Thottakkara P,et al. The Pattern of Longitudinal Change in Serum Creatinine and 90-Day Mortality After Major Surgery[J]. Ann Surg,2016,263(6):1219-1227.
[21] Kheterpal S,Tremper KK,Heung M,et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery:results from a national data set[J]. Anesthesiology,2009,110(3):505-515.
[22] Ko T,Higashitani M,Sato A,et al. Impact of Acute Kidney Injury on Early to Long-Term Outcomes in Patients Who Underwent Surgery for Type A Acute Aortic Dissection[J]. Am J Cardiol,2015,116(3):463-468.
[23]卢冬梅.非心脏手术围术期急性肾损伤研究进展[J].重庆医学,2018,47(10):1373-1375,1379.
[24]吴路加,罗林,童光,等. A型主动脉夹层术后肾脏功能损伤研究进展[J].中国循证心血管医学杂志,2018,10(3):366-369.
[25]叶永科.不同剂量右美托咪定对体外循环下心脏瓣膜置换手术患者血流动力学的影响[J].解放军医药杂志,2017,29(12):96-99.
[26] Sun LY,Wijeysundera DN,Tait GA,et al. Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery[J]. Anesthesiology, 2015,123(3):515-523.
[27] Salmasi V,Maheshwari K,Yang D,et al. Relationship between Intraoperative Hypotension,Defined by Either Reduction from Baseline or Absolute Thresholds,and Acute Kidney and Myocardial Injury after Noncardiac Surgery A Retrospective Cohort Analysis[J]. Anesthesiology,2017,126(1):47-65.
[28] Dellepiane S,Marengo M,Cantaluppi V. Detrimental cross-talk between sepsis and acute kidney injury:new pathogenic mechanisms,early biomarkers and targeted therapies[J]. Crit Care,2016,20:61.
[29] Zhang WR,Garg AX,Coca SG,et al. Plasma IL-6 and IL-10Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery[J]. J Am Soc Nephrol,2015,26(12):3123-3132.
[30] Lahiri R,Derwa Y,Bashir Z,et al. Systemic Inflammatory Response Syndrome After Major Abdominal Surgery Predicted by Early Upregulation of TLR4 and TLR5[J]. Ann Surg,2016,263(5):1028-1037.
[31] Jorgensen AL. Contrast-induced nephropathy:pathophysiology and preventive strategies[J]. Crit Care Nurse,2013,33(1):37-46.
[32] Etz CD,von Aspern K,Da Rocha E Silva J,et al. Impact of Perfusion Strategy on Outcome After Repair for Acute Type A Aortic Dissection[J]. Ann Thorac Surg,2014,97(1):78-86.
[33] Sasabuchi Y,Kimura N,Shiotsuka J,et al. Long-Term Survival in Patients With Acute Kidney Injury After Acute Type A Aortic Dissection Repair[J]. Ann Thorac Surg,2016,102(6):2003-2009.