婴幼儿非心脏手术后术中低血压和急性肾损伤
2022-01-04 11:30
摘要译文
婴幼儿非心脏手术后术中低血压和急性肾损伤:一项回顾性队列分析
背 景:
术中血压的年龄和性别特异性参考列线图已经发表,但它们没有确定损害阈值。因此,作者评估了非心脏手术儿童低血压的各种绝对和相对特征与急性肾损伤之间的关系。
方法:
作者使用两个三级护理中心的电子数据进行了回顾性队列研究。他们包括18岁或18岁以下接受全身麻醉非心脏手术的住院患者。术后肾损伤是根据血清肌酐浓度,使用肾脏疾病改善整体预后定义来定义的。作者评估了术中平均动脉压(MAP)绝对最低值或MAP相对基线的最大下降值的潜在肾损害阈值,累计维持时间为5分钟。分别对2岁或以下、2至6岁、6至12岁和12至18岁的儿童进行了分析。
结果:
在64412名接受非心脏手术的儿童中,4506名在术前和术后进行了肌酐评估。
该人群急性肾损伤的发生率为11%(4506人中有499人):
6岁以下儿童为17%,
6至12岁儿童为11%,
青少年为6%,
与成人报告的发病率相似。
持续5分钟的最低累积MAP与术后肾损伤之间没有相关性。
同样,最大累积MAP减少百分比与术后肾损伤之间也没有相关性。
最低MAP每降低5 mmHg,调整后的肾损伤估计风险为0.99(95%CI,0.94至1.05)。
与基线相比,最大MAP每降低5%,调整后的肾损伤估计风险为1.00(95%CI,0.97至1.03)。
结论:
与成人相比,作者未发现术中低血压与术后肾损伤之间存在任何关联。
在试图预防儿科患者术中肾损伤时,避免短期低血压不应是临床医生的主要关注点。
原文摘要
Intraoperative Hypotension and Acute Kidney Injury after Noncardiac Surgery in Infants and Children: A Retrospective Cohort Analysis
Background: Age- and sex-specific reference nomograms for intraoperative blood pressure have been published, but they do not identify harm thresholds. The authors therefore assessed the relationship between various absolute and relative characterizations of hypotension and acute kidney injury in children having noncardiac surgery.
Methods: The authors conducted a retrospective cohort study using electronic data from two tertiary care centers. They included inpatients 18 yr or younger who had noncardiac surgery with general anesthesia. Postoperative renal injury was defined using the Kidney Disease Improving Global Outcomes definitions, based on serum creatinine concentrations. The authors evaluated potential renal harm thresholds for absolute lowest intraoperative mean arterial pressure (MAP) or largest MAP reduction from baseline maintained for a cumulative period of 5 min. Separate analyses were performed in children aged 2 yr or younger, 2 to 6 yr, 6 to 12 yr, and 12 to 18 yr.
Results: Among 64,412 children who had noncardiac surgery, 4,506 had creatinine assessed preoperatively and postoperatively. The incidence of acute kidney injury in this population was 11% (499 of 4,506): 17% in children under 6 yr old, 11% in children 6 to 12 yr old, and 6% in adolescents, which is similar to the incidence reported in adults. There was no association between lowest cumulative MAP sustained for 5 min and postoperative kidney injury. Similarly, there was no association between largest cumulative percentage MAP reduction and postoperative kidney injury. The adjusted estimated odds for kidney injury was 0.99 (95% CI, 0.94 to 1.05) for each 5-mmHg decrease in lowest MAP and 1.00 (95% CI, 0.97 to 1.03) for each 5% decrease in largest MAP reduction from baseline.
Conclusions: In distinct contrast to adults, the authors did not find any association between intraoperative hypotension and postoperative renal injury. Avoiding short periods of hypotension should not be the clinician's primary concern when trying to prevent intraoperative renal injury in pediatric patients.
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急性,儿童,损伤,血压,心脏
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