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Article(id=1203002061953659078, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203002056400396334, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2023.06.0694, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1655222400000, receivedDateStr=2022-06-15, revisedDate=null, revisedDateStr=null, acceptedDate=1658505600000, acceptedDateStr=2022-07-23, onlineDate=1764747642266, onlineDateStr=2025-12-03, pubDate=1687881600000, pubDateStr=2023-06-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1764747642266, onlineIssueDateStr=2025-12-03, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1764747642266, creator=13701087609, updateTime=1764747642266, updator=13701087609, issue=Issue{id=1203002056400396334, tenantId=1146029695717560320, journalId=1189873630562394117, year='2023', volume='48', issue='6', pageStart='627', pageEnd='748', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1764747640943, creator=13701087609, updateTime=1764747714497, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1203002364979540735, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203002056400396334, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1203002364979540736, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1203002056400396334, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=694, endPage=701, ext={EN=ArticleExt(id=1203002062310174930, articleId=1203002061953659078, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Relationship between perioperative hemoglobin concentration and acute kidney injury after lobectomy, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the relationship between perioperative hemoglobin (HGB) concentration and acute kidney injury (AKI) after pulmonary lobectomy. Methods Patients, who received selective pulmonary lobectomy under general anesthesia in Peking University First Hospital from July 2017 to December 2019, were recruited and divided into low HGB group (HGB<120.0 g/L; n=230) and normal group (HGB≥120.0 g/L, n=1522) according to the HGB concentration before surgery. And the primary endpoint was the incidence of AKI after surgery. Multivariate logistic regression model was used to analyze the influence of preoperative HGB, minimum HGB concentration during surgery and the decrease of HGB concentration after surgery on postoperative AKI. Results A total of 1752 patients were involved in the study, and the overall incidence of postoperative AKI was 2.3%. The incidence of AKI was significantly higher in low HGB group than in normal group [5.7% (13/230) vs. 1.8% (28/1522), RR=3.197, 95%CI 1.631-6.266, P=0.001]. Multivariate logistic regression analysis showed that the risk of postoperative AKI increased to 3.590 (95%CI 1.765-7.303, P<0.001) times if preoperative HGB concentration being lower than 120.0 g/L, and that the risk of postoperative AKI increased to 2.751 (95%CI 1.633-4.635, P<0.001) times for every 15.0 g/L reduction of preoperative HGB. Moreover, the independent risk factors involved preoperative eGFR <60 ml/ (min.1.73 m2), intraoperative infusion rate <5 ml/ (kg·h) and intraoperative urine output <0.8 ml/ (kg·h) (P<0.05). In addition, multivariate logistic regression models also showed that minimum HGB concentration during surgery (OR=0.933, 95%CI 0.780-1.114, P=0.442) and the decrease of HGB concentration after surgery (OR=0.900, 95%CI 0.630-1.287, P=0.565) were not independent risk factors of postoperative AKI. Conclusion Preoperative HGB <120.0 g/L is an independent risk factor of postoperative AKI after pulmonary lobectomy.

, correspAuthors=Zhao-Ting Meng, authorNote=null, correspAuthorsNote=
* E-mail:
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目的 探讨围手术期血红蛋白（HGB）浓度与肺叶切除术后急性肾损伤（AKI）的关系。方法 纳入2017年7月－2019年12月于北京大学第一医院在全身麻醉下行择期肺叶切除术的患者，按照术前HGB浓度分为低HGB组（HGB<120.0 g/L，n=230）与正常组（HGB≥120.0 g/L，n=1522）。主要观察指标为术后AKI发生率。采用多因素logistic回归分析术前HGB、术中最低HGB及术后HGB降低幅度与术后AKI的关系。结果 共纳入1752例患者，术后AKI发生率为2.3%。低HGB组AKI发生率高于正常组[5.7%（13/230）vs. 1.8%（28/1522），RR=3.197，95%CI 1.631～6.266，P=0.001]。多因素logistic回归分析显示，术前HGB<120.0 g/L使术后AKI风险增加至3.590倍（95%CI 1.765～7.303，P<0.001）；HGB浓度每降低1个等级，AKI的发生风险增加至2.751倍（95%CI 1.633～4.635，P<0.001）；此外，术前eGFR<60 ml/（min.1.73 m2）、术中输液速度<5 ml/（kg·h）和术中尿量<0.8 ml/（kg·h）是术后AKI发生的独立危险因素（P<0.05）。而术中最低HGB（OR=0.933，95%CI 0.780～1.114，P=0.442）和术后HGB降低幅度（OR=0.900，95%CI 0.630～1.287，P=0.565）与AKI的发生无明显关系。结论 术前HGB<120.0 g/L是肺叶切除术后AKI发生的独立危险因素。

, correspAuthors=孟昭婷, authorNote=null, correspAuthorsNote=
孟昭婷，E-mail：
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邢茂炜，博士研究生，主要从事围手术期并发症危险因素及干预措施方面的研究

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邢茂炜，博士研究生，主要从事围手术期并发症危险因素及干预措施方面的研究

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邢茂炜，博士研究生，主要从事围手术期并发症危险因素及干预措施方面的研究

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Risk factors and predictive value of acute kidney injury after laparoscopic partial nephrectomy [J]. Med J Chin PLA, 2022, 47（5）: 493-499., articleTitle=Risk factors and predictive value of acute kidney injury after laparoscopic partial nephrectomy, refAbstract=null), Reference(id=1203008550944596881, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2022, volume=47, issue=5, pageStart=493, pageEnd=499, url=null, language=null, rfNumber=[1], rfOrder=1, authorNames=范春玲, 刘永哲, journalName=解放军医学杂志, refType=null, unstructuredReference=[范春玲, 刘永哲. 腹腔镜下肾部分切除术后急性肾损伤的危险因素及其预测价值[J]. 解放军医学杂志, 2022, 47（5）: 493-499.], articleTitle=腹腔镜下肾部分切除术后急性肾损伤的危险因素及其预测价值, refAbstract=null), Reference(id=1203008551032677270, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=10, pageStart=17, pageEnd=1545, url=null, language=null, rfNumber=[2], rfOrder=2, authorNames=Boyer N, Eldridge J, Prowle JR, journalName=Clin J Am Soc Nephrol, refType=null, unstructuredReference=Boyer N, Eldridge J, Prowle JR, et al. Postoperative AKI [J]. Clin J Am Soc Nephrol, 2022, 17（10）: 1535-1545., articleTitle=Postoperative AKI, refAbstract=null), Reference(id=1203008551145923482, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2017, volume=null, issue=4, pageStart=125, pageEnd=1232, url=null, language=null, rfNumber=[3], rfOrder=3, authorNames=Meersch M, Schmidt C, Zarbock A, journalName=Anesth Analg, refType=null, unstructuredReference=Meersch M, Schmidt C, Zarbock A. Perioperative acute kidney injury: an under-recognized problem [J]. Anesth Analg, 2017, 125（4）: 1223-1232., articleTitle=Perioperative acute kidney injury: an under-recognized problem, refAbstract=null), Reference(id=1203008551242392477, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=null, pageStart=8, pageEnd=null, url=null, language=null, rfNumber=[4], rfOrder=4, authorNames=Yu X, Feng Z, journalName=Front Med（Lausanne）, refType=null, unstructuredReference=Yu X, Feng Z. Analysis of risk factors for perioperative acute kidney injury and management strategies [J]. Front Med（Lausanne）, 2021, 8: 751793., articleTitle=Analysis of risk factors for perioperative acute kidney injury and management strategies, refAbstract=null), Reference(id=1203008551334667170, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2013, volume=null, issue=9, pageStart=2013, pageEnd=null, url=null, language=null, rfNumber=[5], rfOrder=5, authorNames=Zacharias M, Mugawar M, Herbison GP, journalName=Cochrane Database Syst Rev, refType=null, unstructuredReference=Zacharias M, Mugawar M, Herbison GP, et al. Interventions for protecting renal function in the perioperative period [J].Cochrane Database Syst Rev, 2013, 2013（9）: CD003590., articleTitle=Interventions for protecting renal function in the perioperative period, refAbstract=null), Reference(id=1203008551418553254, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=6, pageStart=122, pageEnd=965, url=null, language=null, rfNumber=[6], rfOrder=6, authorNames=Sreenivasan J, Zhuo M, Khan MS, journalName=Am J Cardiol, refType=null, unstructuredReference=Sreenivasan J, Zhuo M, Khan MS, et al. Anemia（hemoglobin≤13 g/dl）as a risk factor for contrast-induced acute kidney injury following coronary angiography [J]. Am J Cardiol, 2018, 122（6）: 961-965., articleTitle=Anemia（hemoglobin≤13 g/dl）as a risk factor for contrast-induced acute kidney injury following coronary angiography, refAbstract=null), Reference(id=1203008551506633642, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2017, volume=null, issue=3, pageStart=51, pageEnd=138, url=null, language=null, rfNumber=[7], rfOrder=7, authorNames=Gorla R, Tsagakis K, Horacek M, journalName=Vasc Endovascular Surg, refType=null, unstructuredReference=Gorla R, Tsagakis K, Horacek M, et al. Impact of preoperative anemia and postoperative hemoglobin drop on the incidence of acute kidney injury and in-hospital mortality in patients with type B acute aortic syndromes undergoing thoracic endovascular aortic repair [J]. Vasc Endovascular Surg, 2017, 51（3）: 131-138., articleTitle=Impact of preoperative anemia and postoperative hemoglobin drop on the incidence of acute kidney injury and in-hospital mortality in patients with type B acute aortic syndromes undergoing thoracic endovascular aortic repair, refAbstract=null), Reference(id=1203008551598908333, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2017, volume=null, issue=4, pageStart=43, pageEnd=308, url=null, language=null, rfNumber=[8], rfOrder=8, authorNames=Haase-Fielitz A, Haase M, Bellomo R, journalName=Blood Purif, refType=null, unstructuredReference=Haase-Fielitz A, Haase M, Bellomo R, et al. Perioperative hemodynamic instability and fluid overload are associated with increasing acute kidney injury severity and worse outcome after cardiac surgery [J]. Blood Purif, 2017, 43（4）: 298-308., articleTitle=Perioperative hemodynamic instability and fluid overload are associated with increasing acute kidney injury severity and worse outcome after cardiac surgery, refAbstract=null), Reference(id=1203008551686988718, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2013, volume=null, issue=4, pageStart=117, pageEnd=931, url=null, language=null, rfNumber=[9], rfOrder=9, authorNames=Walsh M, Garg AX, Devereaux PJ, journalName=Anesth Analg, refType=null, unstructuredReference=Walsh M, Garg AX, Devereaux PJ, et al. The association between perioperative hemoglobin and acute kidney injury in patients having noncardiac surgery [J]. Anesth Analg, 2013, 117（4）: 924-931., articleTitle=The association between perioperative hemoglobin and acute kidney injury in patients having noncardiac surgery, refAbstract=null), Reference(id=1203008551804429234, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=null, pageStart=123, pageEnd=159, url=null, language=null, rfNumber=[10], rfOrder=10, authorNames=Cardinale D, Cosentino N, Moltrasio M, journalName=Lung Cancer, refType=null, unstructuredReference=Cardinale D, Cosentino N, Moltrasio M, et al. Acute kidney injury after lung cancer surgery: Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide [J]. Lung Cancer, 2018, 123: 155-159., articleTitle=Acute kidney injury after lung cancer surgery: Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide, refAbstract=null), Reference(id=1203008551905092534, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=3, pageStart=10, pageEnd=null, url=null, language=null, rfNumber=[11], rfOrder=11, authorNames=Rungkitwattanakul D, Chaijamorn W, Han E, journalName=Pharmacy（Basel）, refType=null, unstructuredReference=Rungkitwattanakul D, Chaijamorn W, Han E, et al. Kidney function assessment in African American patients: a narrative review for pharmacists [J]. Pharmacy（Basel）, 2022, 10（3）: 65., articleTitle=Kidney function assessment in African American patients: a narrative review for pharmacists, refAbstract=null), Reference(id=1203008551972201402, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2019, volume=null, issue=6, pageStart=39, pageEnd=542, url=null, language=null, rfNumber=[12], rfOrder=12, authorNames=Heyman SN, Khamaisi M, Zorbavel D, journalName=Semin Nephrol, refType=null, unstructuredReference=Heyman SN, Khamaisi M, Zorbavel D, et al. Role of hypoxia in renal failure caused by nephrotoxins and hypertonic solutions [J].Semin Nephrol, 2019, 39（6）: 530-542., articleTitle=Role of hypoxia in renal failure caused by nephrotoxins and hypertonic solutions, refAbstract=null), Reference(id=1203008552047698876, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2015, volume=null, issue=4, pageStart=62, pageEnd=384, url=null, language=null, rfNumber=[13], rfOrder=13, authorNames=Karkouti K, Grocott HP, Hall R, journalName=Can J Anaesth, refType=null, unstructuredReference=Karkouti K, Grocott HP, Hall R, et al. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study [J]. Can J Anaesth, 2015, 62（4）: 377-384., articleTitle=Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study, refAbstract=null), Reference(id=1203008552135779260, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2017, volume=null, issue=11, pageStart=13, pageEnd=711, url=null, language=null, rfNumber=[14], rfOrder=14, authorNames=Wang Y, Bellomo R, journalName=Nat Rev Nephrol, refType=null, unstructuredReference=Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment [J]. Nat Rev Nephrol, 2017, 13（11）: 697-711., articleTitle=Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment, refAbstract=null), Reference(id=1203008552215471040, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2019, volume=null, issue=3, pageStart=34, pageEnd=360, url=null, language=null, rfNumber=[15], rfOrder=15, authorNames=Yuan SM, journalName=Braz J Cardiovasc Surg, refType=null, unstructuredReference=Yuan SM. Acute kidney injury after cardiac surgery: risk factors and novel biomarkers [J]. Braz J Cardiovasc Surg, 2019, 34（3）: 352-360., articleTitle=Acute kidney injury after cardiac surgery: risk factors and novel biomarkers, refAbstract=null), Reference(id=1203008552303551424, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2011, volume=null, issue=3, pageStart=91, pageEnd=850, url=null, language=null, rfNumber=[16], rfOrder=16, authorNames=Licker M, Cartier V, Robert J, journalName=Ann Thorac Surg, refType=null, unstructuredReference=Licker M, Cartier V, Robert J, et al. Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery [J].Ann Thorac Surg, 2011, 91（3）: 844-850., articleTitle=Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery, refAbstract=null), Reference(id=1203008552379048899, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2012, volume=null, issue=6, pageStart=114, pageEnd=1262, url=null, language=null, rfNumber=[17], rfOrder=17, authorNames=Ishikawa S, Griesdale DEG, Lohser J, journalName=Anesth Analg, refType=null, unstructuredReference=Ishikawa S, Griesdale DEG, Lohser J. Acute kidney injury after lung resection surgery: incidence and perioperative risk factors [J]. Anesth Analg, 2012, 114（6）: 1256-1262., articleTitle=Acute kidney injury after lung resection surgery: incidence and perioperative risk factors, refAbstract=null), Reference(id=1203008552467129287, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2012, volume=null, issue=3, pageStart=101, pageEnd=e129, url=null, language=null, rfNumber=[18], rfOrder=18, authorNames=Kavaz A, Ozçakar ZB, Kendirli T, journalName=Acta Paediatr, refType=null, unstructuredReference=Kavaz A, Ozçakar ZB, Kendirli T, et al. Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria [J]. Acta Paediatr, 2012, 101（3）: e126-e129., articleTitle=Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria, refAbstract=null), Reference(id=1203008552567792582, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2010, volume=null, issue=3, pageStart=38, pageEnd=939, url=null, language=null, rfNumber=[19], rfOrder=19, authorNames=Schneider J, Khemani R, Grushkin C, journalName=Crit Care Med, refType=null, unstructuredReference=Schneider J, Khemani R, Grushkin C, et al. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit [J]. Crit Care Med, 2010, 38（3）: 933-939., articleTitle=Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit, refAbstract=null), Reference(id=1203008552660067275, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2015, volume=null, issue=1, pageStart=87, pageEnd=73, url=null, language=null, rfNumber=[20], rfOrder=20, authorNames=Thomas ME, Blaine C, Dawnay A, journalName=Kidney Int, refType=null, unstructuredReference=Thomas ME, Blaine C, Dawnay A, et al. The definition of acute kidney injury and its use in practice [J]. Kidney Int, 2015, 87（1）: 62-73., articleTitle=The definition of acute kidney injury and its use in practice, refAbstract=null), Reference(id=1203008552777507790, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=20, pageStart=13, pageEnd=1160, url=null, language=null, rfNumber=[21], rfOrder=21, authorNames=Li Q, Zhao M, Wang X, journalName=Clin Interv Aging, refType=null, unstructuredReference=Li Q, Zhao M, Wang X. AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria [J]. Clin Interv Aging, 2018, 13（20）: 1151-1160., articleTitle=AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria, refAbstract=null), Reference(id=1203008552882365394, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2015, volume=null, issue=9, pageStart=26, pageEnd=2238, url=null, language=null, rfNumber=[22], rfOrder=22, authorNames=Kellum JA, Sileanu FE, Murugan R, journalName=J Am Soc Nephrol, refType=null, unstructuredReference=Kellum JA, Sileanu FE, Murugan R, et al. Classifying AKI by urine output versus serum creatinine level [J]. J Am Soc Nephrol, 2015, 26（9）: 2231-2238., articleTitle=Classifying AKI by urine output versus serum creatinine level, refAbstract=null), Reference(id=1203008552999805909, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2019, volume=null, issue=3, pageStart=156, pageEnd=603, url=null, language=null, rfNumber=[23], rfOrder=23, authorNames=Ostermann M, Liu K, Kashani K, journalName=Chest, refType=null, unstructuredReference=Ostermann M, Liu K, Kashani K. Fluid management in acute kidney injury [J]. Chest, 2019, 156（3）: 594-603., articleTitle=Fluid management in acute kidney injury, refAbstract=null), Reference(id=1203008553062720470, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2017, volume=null, issue=null, pageStart=6, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=24, authorNames=Horres CR, Adam MA, Sun Z, journalName=Perioper Med（Lond）, refType=null, unstructuredReference=Horres CR, Adam MA, Sun Z, et al. Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review [J]. Perioper Med（Lond）, 2017, 6: 13., articleTitle=Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review, refAbstract=null), Reference(id=1203008553154995161, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=5, pageStart=127, pageEnd=1245, url=null, language=null, rfNumber=[25], rfOrder=25, authorNames=Zarbock A, Koyner JL, Hoste EAJ, journalName=Anesth Analg, refType=null, unstructuredReference=Zarbock A, Koyner JL, Hoste EAJ, et al. Update on perioperative acute kidney injury [J]. Anesth Analg, 2018, 127（5）: 1236-1245., articleTitle=Update on perioperative acute kidney injury, refAbstract=null)], funds=[Fund(id=1203008550609052543, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, awardId=2018YFC2001800, language=EN, fundingSource=National Key Research and Development Program of China(2018YFC2001800), fundOrder=null, country=null), Fund(id=1203008550684550017, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, awardId=2018YFC2001800, language=CN, fundingSource=国家重点研发计划(2018YFC2001800), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1203008546892899024, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, xref=null, ext=[AuthorCompanyExt(id=1203008546897093329, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, companyId=1203008546892899024, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China), AuthorCompanyExt(id=1203008546905481939, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, companyId=1203008546892899024, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=北京大学第一医院麻醉科，北京 100034)])], figs=[ArticleFig(id=1203008549031994172, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=EN, label=Fig.1, caption=Flow chart of patients undergoing pulmonary lobectomy inclusion, figureFileSmall=iAi0V2y9pDE0HQGJYDwVjA==, figureFileBig=TgLG93YuWQC3O4MH0ycGRg==, tableContent=null), ArticleFig(id=1203008549166211908, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=CN, label=图1, caption=肺叶切除患者入选试验流程图

HGB. 血红蛋白；a终末期肾病定义为eGFR<15 ml/（min.1.73 m2）或接受血液透析治疗；b呋塞米或甘露醇

, figureFileSmall=iAi0V2y9pDE0HQGJYDwVjA==, figureFileBig=TgLG93YuWQC3O4MH0ycGRg==, tableContent=null), ArticleFig(id=1203008549296235337, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=EN, label=Fig.2, caption=The ROC curve of intraoperative infusion rate used for prediction of postoperative AKI, figureFileSmall=nFc5GUpMh1eNP35P756b4g==, figureFileBig=wT0b6InT2MvjINAqnyeTQA==, tableContent=null), ArticleFig(id=1203008549443035983, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=CN, label=图2, caption=肺叶切除术中输液速度用于预测术后AKI的ROC曲线

AKI. 急性肾损伤；A. 术中输液速度；B. 术中尿量

, figureFileSmall=nFc5GUpMh1eNP35P756b4g==, figureFileBig=wT0b6InT2MvjINAqnyeTQA==, tableContent=null), ArticleFig(id=1203008549577253717, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=EN, label=Tab.1, caption=

Comparison of the preoperative baseline data of the two groups of pulmonary lobectomy patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目正常组（n=1522）低HGB组（n=230）P
男性[例（%）]810（53.2）54（23.5）<0.001
年龄（岁，$\bar{x}±s$）61.9±10.563.3±11.80.070
体重指数（kg/m2，$\bar{x}±s$）24.7±3.323.2±3.6<0.001
肺恶性肿瘤[例（%）]1343（88.2）203（88.3）0.992
术前合并症[例（%）]
 COPD66（4.3）8（3.5）0.546
 高血压653（42.9）103（44.8）0.592
 冠心病195（12.8）30（13.0）0.922
 外周动脉粥样硬化142（9.3）27（11.7）0.249
 糖尿病282（18.5）54（23.5）0.076
 高脂血症136（8.9）20（8.7）0.905
脑卒中157（10.3）22（9.6）0.726
吸烟史a553（36.3）37（16.1）<0.001
肾切除术史b16（1.1）2（0.9）>0.999
用药史[例（%）]
 阿司匹林148（9.7）25（10.9）0.587
 ACEI50（3.3）6（2.6）0.587
 ARB225（14.8）44（19.1）0.088
 他汀类158（10.4）30（13.0）0.224
 利尿药50（3.3）9（3.9）0.623
术前化验检查
 血肌酐[μmol/L，M（Q1，Q3）]71.9（63.0，81.4）64.0（58.3，75.2）<0.001
 eGFR[ml/（min.1.73m2），M（Q1，Q3）]85.5（75.3，94.6）86.2（73.2，94.5）0.421
 eGFR<60 ml/（min.1.73m2）[例（%）]68（4.5）25（10.9）<0.001
 脱水指数>20c[例（%）]591（38.8）102（44.3）0.111
ASA分级Ⅲ－Ⅳ级[例（%）]273（17.9）55（23.9）0.030
), ArticleFig(id=1203008549711471451, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=CN, label=表1, caption=

两组肺叶切除患者术前基线资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目正常组（n=1522）低HGB组（n=230）P
男性[例（%）]810（53.2）54（23.5）<0.001
年龄（岁，$\bar{x}±s$）61.9±10.563.3±11.80.070
体重指数（kg/m2，$\bar{x}±s$）24.7±3.323.2±3.6<0.001
肺恶性肿瘤[例（%）]1343（88.2）203（88.3）0.992
术前合并症[例（%）]
 COPD66（4.3）8（3.5）0.546
 高血压653（42.9）103（44.8）0.592
 冠心病195（12.8）30（13.0）0.922
 外周动脉粥样硬化142（9.3）27（11.7）0.249
 糖尿病282（18.5）54（23.5）0.076
 高脂血症136（8.9）20（8.7）0.905
脑卒中157（10.3）22（9.6）0.726
吸烟史a553（36.3）37（16.1）<0.001
肾切除术史b16（1.1）2（0.9）>0.999
用药史[例（%）]
 阿司匹林148（9.7）25（10.9）0.587
 ACEI50（3.3）6（2.6）0.587
 ARB225（14.8）44（19.1）0.088
 他汀类158（10.4）30（13.0）0.224
 利尿药50（3.3）9（3.9）0.623
术前化验检查
 血肌酐[μmol/L，M（Q1，Q3）]71.9（63.0，81.4）64.0（58.3，75.2）<0.001
 eGFR[ml/（min.1.73m2），M（Q1，Q3）]85.5（75.3，94.6）86.2（73.2，94.5）0.421
 eGFR<60 ml/（min.1.73m2）[例（%）]68（4.5）25（10.9）<0.001
 脱水指数>20c[例（%）]591（38.8）102（44.3）0.111
ASA分级Ⅲ－Ⅳ级[例（%）]273（17.9）55（23.9）0.030
), ArticleFig(id=1203008549862466402, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=EN, label=Tab.2, caption=

Comparison of intraoperative and postoperative data between the two groups of pulmonary lobectomy patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目正常组（n=1522）低HGB组（n=230）P
手术类型[例（%）]  0.379
 肺叶肺段切除术397（26.1）61（26.5）
 1～2个肺叶切除术1095（71.9）161（70.0）
 3个及以上肺叶切除术30（2.0）8（3.5）
全静脉麻醉[例（%）]302（19.8）40（17.4）0.382
神经阻滞[例（%）]  0.308
 无337（22.1）56（24.3）
 椎旁神经阻滞1114（73.2）168（73.0）
 硬膜外阻滞71（4.7）6（2.6）
术中用药[例（%）]
 七氟醚633（41.6）103（44.8）0.361
 右美托咪定716（47.0）103（44.7）0.522
 氟比洛芬酯1175（77.2）176（76.5）0.819
 帕瑞西布钠147（9.7）20（8.7）0.643
 麻黄碱643（42.2）87（37.8）0.205
 去氧肾上腺素351（23.1）52（22.6）0.879
术中液体出入量
 输液速度a[ml/（kg·h），M（Q1，Q3）]4.95（3.89，6.37）5.65（4.57，7.37）<0.001
 输液速度<5 ml/（kg·h）a[例（%）]777（51.1）75（32.6）<0.001
 人工胶体[例（%）]299（19.6）57（24.8）0.071
 异体红细胞[例（%）]26（1.7）11（4.8）0.006
 异体血浆[例（%）]26（1.7）7（3.0）0.187
 出血量[ml，M（Q1，Q3）]50（1，100）50（9，103）0.152
 尿量b[ml/（kg·h），M（Q1，Q3）]1.24（0.78，2.02）1.69（0.99，2.62）<0.001
 尿量<0.8 ml/（kg·h）b[例（%）]390（25.6）42（18.3）0.016
术中监测
 最低HGB浓度[g/L，M（Q1，Q3）]133.0（123.0，147.0）（n=1323）c112.0（105.0，123.0）（n=211）c<0.001
 SBP<90 mmHg [例（%）]1022（67.1）148（64.3）0.401
 SBP<90 mmHg持续超过30 min [例（%）]321（21.1）51（22.2）0.708
 SpO2<90% [例（%）]303（19.9）55（23.9）0.160
麻醉时间[min，M（Q1，Q3）]272（215，330）260（212，332）0.484
手术时间[min，M（Q1，Q3）]184（137，238）184（140，242）0.749
术后24 h最低HGB浓度[g/L，M（Q1，Q3）]131.0（123.0，140.0）111.0（103.0，116.0）<0.001
术后24 hHGB降低幅度d[例（%）]  <0.001
 无（0级）404（26.5）93（40.4）
 0.1～10.0 g/L（1级）681（44.7）99（43.0）
 10.1～20.0 g/L（2级）330（21.7）30（13.0）
 20.1～30.0 g/L（3级）80（5.3）7（3.0）
 >30.0 g/L（4级）27（1.8）1（0.4）
术后AKI[例（%）]28（1.8）13（5.7）<0.001
), ArticleFig(id=1203008549984101220, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=CN, label=表2, caption=

两组肺叶切除患者术中及术后资料比较

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项目正常组（n=1522）低HGB组（n=230）P
手术类型[例（%）]  0.379
 肺叶肺段切除术397（26.1）61（26.5）
 1～2个肺叶切除术1095（71.9）161（70.0）
 3个及以上肺叶切除术30（2.0）8（3.5）
全静脉麻醉[例（%）]302（19.8）40（17.4）0.382
神经阻滞[例（%）]  0.308
 无337（22.1）56（24.3）
 椎旁神经阻滞1114（73.2）168（73.0）
 硬膜外阻滞71（4.7）6（2.6）
术中用药[例（%）]
 七氟醚633（41.6）103（44.8）0.361
 右美托咪定716（47.0）103（44.7）0.522
 氟比洛芬酯1175（77.2）176（76.5）0.819
 帕瑞西布钠147（9.7）20（8.7）0.643
 麻黄碱643（42.2）87（37.8）0.205
 去氧肾上腺素351（23.1）52（22.6）0.879
术中液体出入量
 输液速度a[ml/（kg·h），M（Q1，Q3）]4.95（3.89，6.37）5.65（4.57，7.37）<0.001
 输液速度<5 ml/（kg·h）a[例（%）]777（51.1）75（32.6）<0.001
 人工胶体[例（%）]299（19.6）57（24.8）0.071
 异体红细胞[例（%）]26（1.7）11（4.8）0.006
 异体血浆[例（%）]26（1.7）7（3.0）0.187
 出血量[ml，M（Q1，Q3）]50（1，100）50（9，103）0.152
 尿量b[ml/（kg·h），M（Q1，Q3）]1.24（0.78，2.02）1.69（0.99，2.62）<0.001
 尿量<0.8 ml/（kg·h）b[例（%）]390（25.6）42（18.3）0.016
术中监测
 最低HGB浓度[g/L，M（Q1，Q3）]133.0（123.0，147.0）（n=1323）c112.0（105.0，123.0）（n=211）c<0.001
 SBP<90 mmHg [例（%）]1022（67.1）148（64.3）0.401
 SBP<90 mmHg持续超过30 min [例（%）]321（21.1）51（22.2）0.708
 SpO2<90% [例（%）]303（19.9）55（23.9）0.160
麻醉时间[min，M（Q1，Q3）]272（215，330）260（212，332）0.484
手术时间[min，M（Q1，Q3）]184（137，238）184（140，242）0.749
术后24 h最低HGB浓度[g/L，M（Q1，Q3）]131.0（123.0，140.0）111.0（103.0，116.0）<0.001
术后24 hHGB降低幅度d[例（%）]  <0.001
 无（0级）404（26.5）93（40.4）
 0.1～10.0 g/L（1级）681（44.7）99（43.0）
 10.1～20.0 g/L（2级）330（21.7）30（13.0）
 20.1～30.0 g/L（3级）80（5.3）7（3.0）
 >30.0 g/L（4级）27（1.8）1（0.4）
术后AKI[例（%）]28（1.8）13（5.7）<0.001
), ArticleFig(id=1203008550101541738, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=EN, label=Tab.3, caption=

Analysis of the independent risk factors of AKI after pneumonectomy

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因素单因素logistic分析多因素logistic分析
OR（95%CI）POR（95%CI）P
术前eGFR<60 ml/（min·1.73 m2）4.637（2.078～10.348）<0.0013.524（1.499～8.287）0.004
ASA分级Ⅲ－Ⅳ级1.827（0.922～3.619）0.0841.315（0.637～2.717）0.459
术中输液速度<5 ml/（kg·h）2.071（1.079～3.977）0.0292.250（1.142～4.433）0.019
术中尿量<0.8 ml/（kg·h）2.212（1.177～4.158）0.0142.170（1.132～4.158）0.020
术前HGB＜120.0 g/L3.197（1.631～6.266）0.0013.590（1.765～7.303）<0.001
), ArticleFig(id=1203008550227370862, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=CN, label=表3, caption=

肺叶切除术后AKI的危险因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素单因素logistic分析多因素logistic分析
OR（95%CI）POR（95%CI）P
术前eGFR<60 ml/（min·1.73 m2）4.637（2.078～10.348）<0.0013.524（1.499～8.287）0.004
ASA分级Ⅲ－Ⅳ级1.827（0.922～3.619）0.0841.315（0.637～2.717）0.459
术中输液速度<5 ml/（kg·h）2.071（1.079～3.977）0.0292.250（1.142～4.433）0.019
术中尿量<0.8 ml/（kg·h）2.212（1.177～4.158）0.0142.170（1.132～4.158）0.020
术前HGB＜120.0 g/L3.197（1.631～6.266）0.0013.590（1.765～7.303）<0.001
), ArticleFig(id=1203008550336422769, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=EN, label=Tab.4, caption=

Relationship between the preoperative HGB，the intraoperative minimum HGB，the postoperative decreased HGB and postoperative AKI

, figureFileSmall=null, figureFileBig=null, tableContent=
因素多因素回归分析a
OR（95%CI）Pb
术前HGB每降低1个等级c2.751（1.633～4.635）<0.001
术前HGB等级d
 正常（≥120.0 g/L）参照值参照值
 轻度降低（105.0～119.9 g/L）2.902（1.302～6.466）0.009
 中度降低（90.0～104.9 g/L）7.186（2.138～24.150）0.001
术中最低HGB0.933（0.780～1.114）0.442
术后24 hHGB降低幅度e0.900（0.630～1.287）0.565
), ArticleFig(id=1203008550428697460, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1203002061953659078, language=CN, label=表4, caption=

肺叶切除术前HGB、术中最低HGB及术后HGB降低与术后AKI的关系

, figureFileSmall=null, figureFileBig=null, tableContent=
因素多因素回归分析a
OR（95%CI）Pb
术前HGB每降低1个等级c2.751（1.633～4.635）<0.001
术前HGB等级d
 正常（≥120.0 g/L）参照值参照值
 轻度降低（105.0～119.9 g/L）2.902（1.302～6.466）0.009
 中度降低（90.0～104.9 g/L）7.186（2.138～24.150）0.001
术中最低HGB0.933（0.780～1.114）0.442
术后24 hHGB降低幅度e0.900（0.630～1.287）0.565
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围手术期血红蛋白浓度与肺叶切除术后急性肾损伤的关系
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邢茂炜 , 穆东亮 , 孟昭婷 *
解放军医学杂志 | 临床研究 2023,48(6): 694-701
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解放军医学杂志 | 临床研究 2023, 48(6): 694-701
围手术期血红蛋白浓度与肺叶切除术后急性肾损伤的关系
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邢茂炜, 穆东亮, 孟昭婷*
作者信息
  • 北京大学第一医院麻醉科，北京 100034

    • 邢茂炜，博士研究生，主要从事围手术期并发症危险因素及干预措施方面的研究

通讯作者:

孟昭婷，E-mail：
Relationship between perioperative hemoglobin concentration and acute kidney injury after lobectomy
Mao-Wei Xing, Dong-Liang Mu, Zhao-Ting Meng*
Affiliations
  • Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
出版时间: 2023-06-28 doi: 10.11855/j.issn.0577-7402.2023.06.0694
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摘要
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目的 探讨围手术期血红蛋白（HGB）浓度与肺叶切除术后急性肾损伤（AKI）的关系。方法 纳入2017年7月－2019年12月于北京大学第一医院在全身麻醉下行择期肺叶切除术的患者，按照术前HGB浓度分为低HGB组（HGB<120.0 g/L，n=230）与正常组（HGB≥120.0 g/L，n=1522）。主要观察指标为术后AKI发生率。采用多因素logistic回归分析术前HGB、术中最低HGB及术后HGB降低幅度与术后AKI的关系。结果 共纳入1752例患者，术后AKI发生率为2.3%。低HGB组AKI发生率高于正常组[5.7%（13/230）vs. 1.8%（28/1522），RR=3.197，95%CI 1.631～6.266，P=0.001]。多因素logistic回归分析显示，术前HGB<120.0 g/L使术后AKI风险增加至3.590倍（95%CI 1.765～7.303，P<0.001）；HGB浓度每降低1个等级，AKI的发生风险增加至2.751倍（95%CI 1.633～4.635，P<0.001）；此外，术前eGFR<60 ml/（min.1.73 m2）、术中输液速度<5 ml/（kg·h）和术中尿量<0.8 ml/（kg·h）是术后AKI发生的独立危险因素（P<0.05）。而术中最低HGB（OR=0.933，95%CI 0.780～1.114，P=0.442）和术后HGB降低幅度（OR=0.900，95%CI 0.630～1.287，P=0.565）与AKI的发生无明显关系。结论 术前HGB<120.0 g/L是肺叶切除术后AKI发生的独立危险因素。

肺叶切除术  /  血红蛋白  /  急性肾损伤  /  危险因素

Objective To explore the relationship between perioperative hemoglobin (HGB) concentration and acute kidney injury (AKI) after pulmonary lobectomy. Methods Patients, who received selective pulmonary lobectomy under general anesthesia in Peking University First Hospital from July 2017 to December 2019, were recruited and divided into low HGB group (HGB<120.0 g/L; n=230) and normal group (HGB≥120.0 g/L, n=1522) according to the HGB concentration before surgery. And the primary endpoint was the incidence of AKI after surgery. Multivariate logistic regression model was used to analyze the influence of preoperative HGB, minimum HGB concentration during surgery and the decrease of HGB concentration after surgery on postoperative AKI. Results A total of 1752 patients were involved in the study, and the overall incidence of postoperative AKI was 2.3%. The incidence of AKI was significantly higher in low HGB group than in normal group [5.7% (13/230) vs. 1.8% (28/1522), RR=3.197, 95%CI 1.631-6.266, P=0.001]. Multivariate logistic regression analysis showed that the risk of postoperative AKI increased to 3.590 (95%CI 1.765-7.303, P<0.001) times if preoperative HGB concentration being lower than 120.0 g/L, and that the risk of postoperative AKI increased to 2.751 (95%CI 1.633-4.635, P<0.001) times for every 15.0 g/L reduction of preoperative HGB. Moreover, the independent risk factors involved preoperative eGFR <60 ml/ (min.1.73 m2), intraoperative infusion rate <5 ml/ (kg·h) and intraoperative urine output <0.8 ml/ (kg·h) (P<0.05). In addition, multivariate logistic regression models also showed that minimum HGB concentration during surgery (OR=0.933, 95%CI 0.780-1.114, P=0.442) and the decrease of HGB concentration after surgery (OR=0.900, 95%CI 0.630-1.287, P=0.565) were not independent risk factors of postoperative AKI. Conclusion Preoperative HGB <120.0 g/L is an independent risk factor of postoperative AKI after pulmonary lobectomy.

lobectomy  /  hemoglobin  /  acute kidney injury  /  risk factors
邢茂炜, 穆东亮, 孟昭婷. 围手术期血红蛋白浓度与肺叶切除术后急性肾损伤的关系. 解放军医学杂志, 2023 , 48 (6) : 694 -701 . DOI: 10.11855/j.issn.0577-7402.2023.06.0694
Mao-Wei Xing, Dong-Liang Mu, Zhao-Ting Meng. Relationship between perioperative hemoglobin concentration and acute kidney injury after lobectomy[J]. Medical Journal of Chinese People’s Liberation Army, 2023 , 48 (6) : 694 -701 . DOI: 10.11855/j.issn.0577-7402.2023.06.0694
正文
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急性肾损伤（acute kidney injury，AKI）是围手术期的常见并发症[1]，不同手术后其发生率为5%～30%，其中胸科手术后为3%～9%。AKI与患者不良预后密切相关，如增高术后并发症发生率、术后30 d病死率以及延长住院时间等[2]。有研究显示，有效的预防措施可使AKI发生风险降低50%以上[3]，因此，已有多项研究关注诱发AKI的可逆性因素，并对其进行干预以降低术后AKI的发生率[4-5]。血红蛋白（hemoglobin，HGB）是向器官和组织输送氧气的关键载体。有研究显示，心脏手术患者术前HGB≤130.0 g/L可使术后AKI发生风险增加4倍[6]；术后HGB的降低幅度被认为是心脏手术后AKI发生的独立危险因素[7]。尽管上述研究结果表明围手术期HGB波动是导致AKI发生的重要危险因素[8]，但目前仍缺少非心脏手术尤其是肺癌手术相关的研究证据。一项回顾性研究显示，非心脏手术患者术前HGB<120.0 g/L可使术后AKI发生风险增加2倍[9]，但该研究未分析不同手术类型中术前HGB及其阈值是否与AKI有关。胸科手术创伤大，血液循环波动大，且术中常采用限制性液体管理策略，该类手术患者面临更高的AKI发生风险[10]，其术前HGB浓度及围手术期HGB降低幅度可能与其他手术类型存在差异。本研究探讨了围手术期HGB浓度与肺叶切除术后AKI的关系。
1 资料与方法
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1.1 研究对象
本研究为回顾性队列研究。纳入2017年7月－2019年12月于北京大学第一医院在全身麻醉下行择期肺叶切除术的患者。排除标准：（1）年龄<18岁；（2）术前估算肾小球滤过率（estimated glomerular filtration rate，eGFR；根据慢性肾脏病流行病学合作研究组肌酐方程计算[11]）<15 ml/（min.1.73 m2）或接受透析治疗；（3）同时行其他外科如心脏外科或泌尿外科手术；（4）术后7 d内行二次手术。本研究获得北京大学第一医院伦理委员会批准（2019-161）。
1.2 主要观察指标
主要观察指标为术后7 d AKI发生率。以患者术前最后一次血肌酐值为基础值。根据改善全球肾脏病预后组织（Kidney Disease Improving Global Outcomes，KDIGO）指南，AKI指术后48 h血肌酐值升高26.5 μmol/L或术后7 d血肌酐值升高至基础值的1.5倍。AKI根据严重程度分为Ⅰ级（血肌酐值升高≥26.5 μmol/L或升高1.5～1.9倍）、Ⅱ级（血肌酐值升高2.0～2.9倍）、Ⅲ级（血肌酐值升高≥353.6 μmol/L或升高≥3倍，或需要启动肾替代治疗）。
1.3 HGB浓度检测
术前HGB浓度采用血常规检测，以术前最后一次检测值为基础值，并分为3个等级：正常（HGB≥120.0 g/L）、轻度降低（HGB 105.0～119.9 g/L）和中度降低（HGB 90.0～104.9 g/L）。
术中HGB浓度采用动脉血气分析检测。根据本院临床常规，在手术开始前及手术结束前分别至少检测一次动脉血气分析，必要时根据患者情况追加检测次数。
术后HGB浓度采用血常规检测。根据本院临床常规，一般在术后第1、2天晨6：00～8：00进行血常规检测，必要时根据患者情况追加检测次数。
术后24 h HGB降低幅度指术前HGB与术后24 h HGB最低值的差值，根据变化幅度分为5个等级：0级（HGB未降低）、1级（HGB降低0.1～10.0 g/L）、2级（HGB降低10.1～20.0 g/L）、3级（HGB降低20.1～30.0 g/L）及4级（HGB降低>30.0 g/L）。
1.4 围手术期管理
所有患者均不使用术前药物。患者入室后，给予心率、心律、无创血压、血氧饱和度（SpO2）和脑电双频指数（Bispectral，BIS）监测；全身麻醉诱导完成后，给予呼气末二氧化碳分压（partial pressure of end-tidal carbon dioxide，PetCO2）、有创动脉压和鼻咽温监测。
麻醉诱导使用丙泊酚或依托咪酯，麻醉维持使用丙泊酚持续输注，并按需给予七氟醚和（或）N2O吸入。术中镇痛采用阿片类药物持续输注维持镇痛，也可采用硬膜外阻滞和椎旁神经阻滞。采用非去极化肌松药维持肌肉松弛。麻醉深度维持在BIS 40～60，血压波动范围维持在基础值的20%以内，体温维持在36～37 ℃。
气道管理采用双腔气管导管或支气管封堵器。通气模式为容量控制通气，潮气量最初设定为6～8 ml/kg，术中调整分钟通气量（MVV）使PetCO2维持在35～45 mmHg。需要时可使用呼气末正压（positive end-expiratory pressure，PEEP），将其设定为5～10 cmH2O。麻醉医师可调整吸入氧浓度（40%～100%）使得SpO2≥92%。
术中乳酸钠林格液的输注速度为3～8 ml/（kg·h）；必要时可使用人工胶体液（羟乙基淀粉或琥珀酰凝胶）。出血量达800 ml以上时考虑输注异体红细胞及其他血制品，目标为维持HGB≥70.0 g/L。在适量补液的前提下，当血压降低超出基础值的20%范围时，可给予升压药（麻黄碱、去氧肾上腺素、去甲肾上腺素等）维持血压稳定。
术后镇痛采用患者自控静脉或硬膜外镇痛，镇痛目标为维持数字分级评分法（NRS，分为11个点，0=无痛，10=最剧烈的疼痛）评分≤3分。
1.5 数据收集
收集患者术前基线资料，包括人口学资料（性别、年龄、身高、体重等），入院诊断，既往病史[脑卒中、慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）及吸烟史、高血压、冠心病、外周动脉粥样硬化、糖尿病、高脂血症]，化验检查结果（血肌酐、血尿素氮、eGFR、脱水指数），用药史[阿司匹林、血管紧张素转换酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻滞剂（ARB）、他汀类药物、利尿药等]，手术治疗史（一侧肾或肾部分切除术），以及ASA分级；术中资料包括手术类型（肺叶切除范围），麻醉方式（是否为全静脉麻醉、是否联合硬膜外阻滞或椎旁神经阻滞），术中用药（七氟醚、右美托咪定、氟比洛芬酯、帕瑞西布钠、麻黄碱、去氧肾上腺素等），术中液体出入量（输液速度、是否输入人工胶体、是否输入异体红细胞、是否输入异体血浆、出血量、尿量），低血压及低氧饱和度发生情况，麻醉时间和手术时间等；术后资料包括术后化验检查（术后24 h最低HGB浓度、术后48 h及术后7 d血肌酐最高值）及术后是否需要肾脏替代治疗等。其中，脱水指数=10×（血尿素氮/3.55）/（血肌酐/88.4）；术中输液速度=术中总输液量/（麻醉时间×体重）；术中尿量=术中总尿量/（麻醉时间×体重）。
1.6 围手术期HGB与术后AKI的关系分析
根据患者术前HGB是否低于120 g/L，将患者分为正常组（HGB≥120.0 g/L）与低HGB组（HGB<120.0 g/L）。采用单因素logistic回归分析和协方差分析筛选可能与AKI相关的变量。将单因素分析中P<0.10的变量纳入多因素logistic回归模型，分析术后AKI的独立危险因素。
为进一步分析围手术期HGB与术后AKI的关系，建立4个多因素logistic回归模型，每个模型中均纳入上述单因素logistic回归分析和协方差分析中P<0.10的变量，此外分别将术前低HGB、术前HGB等级、术中最低HGB、术后24 h HGB降低幅度作为自变量纳入模型，排除存在共线性的自变量后进行多因素logistic回归分析。采用Bonforroni法进行多重检验校正，P<0.013为差异有统计学意义。
1.7 统计学处理
采用SPSS 19.0软件进行统计分析。符合正态分布的计量资料以$\bar{x}±s$表示，组间比较采用独立样本t检验；不符合正态分布的计量资料以M（Q1，Q3）表示，组间比较采用独立样本Mann-Whitney U检验。计数资料及等级资料以例（%）表示，计数资料组间比较采用χ2检验或Fisher精确检验，等级资料组间比较采用趋势χ2检验。采用受试者工作特征（receiver operating characteristic curve，ROC）曲线分析确定术中输液速度和术中尿量的界值。无特殊说明时P<0.05为差异有统计学意义。
2 结果
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2.1 患者入组情况
2017年7月－2019年12月，共1960例患者于北京大学第一医院在全身麻醉下行择期肺叶切除术，其中1952例符合入组标准。其中200例因围手术期尿量及血肌酐检查结果缺失被排除，最终纳入1752例。患者入选流程如图1所示。
2.2 两组患者术前基线资料比较
根据患者术前HGB是否低于120.0 g/L分为低HGB组（n=230）与正常组（n=1522）。低HGB组男性患者比例（P<0.001）、体重指数（P<0.001）、吸烟比例（P<0.001）及术前血肌酐值（P<0.001）明显低于正常组，术前eGFR<60 ml/（min.1.73 m2）及ASA Ⅲ－Ⅳ级患者比例明显高于正常组（P<0.001、P=0.030，表1）。
ROC曲线分析结果显示，术中输液速度、术中尿量的界值分别为5 ml/（kg·h）、0.8 ml/（kg·h）（图2）。低HGB组术中输液速度<5 ml/（kg·h）患者比例（P<0.001）、术中尿量<0.8 ml/（kg·h）患者比例（P=0.016）、术中最低HGB浓度（P<0.001）及术后24 h最低HGB浓度（P<0.001）明显低于正常组，术中输液速度（P<0.001）、术中输注异体红细胞比例（P=0.006）及术中尿量（P<0.001）明显高于正常组；两组术后24 h HGB降低幅度差异有统计学意义（P<0.001）。此外，低HGB组术后AKI发生率明显高于正常组（P<0.001）（表2）。
2.3 术后AKI的危险因素分析
AKI总体发生率为2.3%（41/1752；低HGB组13例，正常组28例），其中87.8%（36/41；低HGB组12例，正常组24例）为AKI Ⅰ级、7.3%（3/41；正常组3例）为AKI Ⅱ级、4.9%（2/41；低HGB组1例，接受了肾替代治疗，正常组1例）为AKI Ⅲ级。
单因素logistic回归分析和协方差分析结果显示，术前eGFR<60 ml/（min.1.73 m2）、ASA分级Ⅲ－Ⅳ级、术中输液速度<5 ml/（kg·h）、术中尿量<0.8 ml/（kg·h）和术前HGB<120.0 g/L与术后AKI的发生相关（P<0.10，表3）。
多因素logistic回归分析结果显示，术前eGFR<60 ml/（min.1.73 m2）（P=0.004）、术中输液速度<5 ml/（kg·h）（P=0.019）、术中尿量<0.8 ml/（kg·h）（P=0.020）和术前HGB<120.0 g/L（P<0.001）为术后AKI的独立危险因素，其中术前HGB<120.0 g/L明显增高了术后AKI的发生率（OR=3.590，95%CI 1.765～7.303，P<0.001）（表3）。
2.4 术前HGB、术中最低HGB及术后HGB降低幅度与术后AKI的关系
术前低HGB（HGB<120.0 g/L）的发生率为13.1%（230/1752），其中轻度降低者占84.8%（195/230），中度降低者占15.2%（35/230），无患者合并HGB<90.0 g/L。
术前HGB浓度每降低1个等级AKI的发生风险增加至2.751倍（95%CI 1.633～4.635，P<0.001，表4）。其中，与HGB≥120.0 g/L相比，HGB轻度降低使术后AKI发生风险增加至2.902倍（95%CI 1.302～6.466，P=0.009），HGB中度降低使术后AKI发生风险增加至7.186倍（95%CI 2.138～24.150，P=0.001，表4）。
低HGB组患者术中最低HGB浓度明显低于正常组[112.0（105.0，123.0）g/L vs. 133.0（123.0，147.0）g/L，P<0.001，表2]。但校正单因素分析中的混杂因素后，术中最低HGB浓度与AKI发生无明显关系（RR=0.933，95%CI 0.780～1.114，P=0.442，表4）。
1255例（71.6%）术后HGB较术前降低，其中1级、2级、3级、4级分别占44.5%、20.5%、5.0%、1.6%。在校正单因素分析中的混杂因素后，术后24 h HGB降低幅度与AKI发生无明显关系（RR=0.900，95%CI 0.630～1.287，P=0.565，表4）。
3 讨论
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本研究以1752例接受择期肺叶切除术的患者为研究对象，探讨术前HGB、术中HGB以及术后HGB降低幅度对术后AKI的影响，结果显示，术后AKI发生率为2.3%，术前HGB<120.0 g/L、术前eGFR<60 ml/（min.1.73 m2）、术中输液速度<5 ml/（kg·h）及术中尿量<0.8 ml/（kg·h）为术后发生AKI的独立危险因素。针对围手术期HGB浓度变化对术后AKI发生影响的分析则显示，术后AKI发生风险随术前HGB浓度降低而升高，但术中最低HGB和术后HGB降低幅度对术后AKI的发生无明显影响。
本研究将HGB<120.0 g/L定义为低HGB，该界值符合成年人轻度贫血的诊断标准。另外，本研究纳入的患者术前未出现中度（HGB<90.0 g/L）及以上的贫血，这与纳入的患者术前一般状况较好、肿瘤分期较早且不存在转移甚至恶病质等情况有关。
低HGB浓度导致AKI的机制尚不清楚，可能与多种机制共同作用有关。首先，低HGB可降低血液携氧能力，引起肾髓质缺氧，这在AKI的发生中起着重要作用[12]；其次，许多贫血患者存在亚临床肾脏疾病，可能增加肾小管耗氧量并加重其氧化应激反应，从而增加患者对肾损伤的易感性[13]。目前多项研究发现，心脏手术患者术前低HGB与术后AKI的发生独立相关[14-15]。一项针对非心脏手术患者的观察性研究也显示，术前HGB≤120.0 g/L与术后AKI独立相关[9]，本研究结果与其一致。但多项肺叶切除术相关研究并未得出类似结论[10，16-17]，这可能与这些研究中的AKI诊断标准与本研究不同有关。上述研究采用危险、损伤、衰竭、肾功能丧失和终末期肾病（the Risk，Injury，Failure，Loss，and End-stage renal disease，RIFLE）诊断标准或急性肾损伤网络（Acute Kidney Injury Network，AKIN）诊断标准，而本研究采用KDIGO诊断标准。有系统综述发现，这些诊断标准在使用中并无显著优劣[18-19]，但临床实践发现，对同一群体使用RIFLE和AKIN两种诊断标准时相互漏诊率较高[20]，因而使用不同诊断标准的研究结果可能不同。KDIGO标准是目前最新最常用的AKI诊断标准，其敏感度较高，可更早检出AKI，且检出的AKI对患者不良预后有较高的预测价值[21]，是目前比较权威的AKI诊断标准。
本研究还发现，术前HGB浓度越低，术后AKI风险越高。以往针对冠脉造影及非心脏手术患者的研究也发现，术后AKI风险随术前HGB的降低而升高[6，9]，提示术前HGB浓度不仅可用于判断预后，还可能作为干预目标用于改善预后。但本研究为观察性研究，仅得出相关关系，不能得出因果关系；因此，增高患者术前HGB浓度能否降低术后AKI的发生风险进而改善预后，尚需进一步研究证实。
本研究未发现术中最低HGB浓度、术中输入异体红细胞、术中出血量，以及围手术期HGB浓度降低等与术后AKI的发生相关。理论上，HGB大幅度下降可降低血液的携氧能力，肾小管对此可能极为敏感[12]。既往研究也发现，术后早期HGB浓度降低是术后AKI的独立危险因素[22]。本研究观察发现，AKI患者术后24 h HGB降低超过30.0 g/L的发生率较非AKI患者高，但差异无统计学意义。这主要与本研究纳入的患者术中出血量较少有关（中位数仅为50 ml）。
此外，本研究还发现，术中输液速度<5 ml/（kg·h）及术中尿量<0.8 ml/（kg·h）也是术后AKI发生的独立危险因素。这两个界值由ROC曲线分析得出，曲线下面积分别为0.592（P=0.044）和0.606（P=0.020），介于0.5～0.7，提示以此为界值界定的“限制输液”和“少尿”对术后AKI的发生仅存在较低的预测价值。术中输液量和尿量与术后AKI的关系一直存在争议。限制输液引起的有效循环血量不足可导致肾脏低灌注的发生，引起AKI，进而表现为少尿[23]。但也有研究发现，限制输液并未引起术后AKI发生率增高[24]。对于围手术期患者，全身麻醉术中少尿可能由疼痛、恶心等非肾损伤因素引起的抗利尿激素分泌增加所致，也可能由手术导致的液体分布和排出改变所致，并不意味着术后AKI的发生[25]。这一问题仍需进一步探讨。
本研究尚存在不足之处，如为回顾性研究，无法获得患者术后尿量，因此仅采用血清肌酐值作为AKI的诊断标准，可能导致AKI发生率被低估。但此方法被大多数研究所采用，且有研究显示，以血肌酐值为依据得到的AKI诊断与不良预后密切相关[20]。此外，本研究为单中心研究，结论外推性受限，其结果仍需多中心研究进一步证实。
综上所述，术前HGB<120.0 g/L是肺叶切除术后发生AKI的独立危险因素，且AKI发生风险随术前HGB的降低而增高。
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排序方式：
[1]
Fan CL, Liu YZ. Risk factors and predictive value of acute kidney injury after laparoscopic partial nephrectomy [J]. Med J Chin PLA, 2022, 47（5）: 493-499.
[范春玲, 刘永哲. 腹腔镜下肾部分切除术后急性肾损伤的危险因素及其预测价值[J]. 解放军医学杂志, 2022, 47（5）: 493-499.]
[2]
Boyer N, Eldridge J, Prowle JR, et al. Postoperative AKI [J]. Clin J Am Soc Nephrol, 2022, 17（10）: 1535-1545.
[3]
Meersch M, Schmidt C, Zarbock A. Perioperative acute kidney injury: an under-recognized problem [J]. Anesth Analg, 2017, 125（4）: 1223-1232.
[4]
Yu X, Feng Z. Analysis of risk factors for perioperative acute kidney injury and management strategies [J]. Front Med（Lausanne）, 2021, 8: 751793.
[5]
Zacharias M, Mugawar M, Herbison GP, et al. Interventions for protecting renal function in the perioperative period [J].Cochrane Database Syst Rev, 2013, 2013（9）: CD003590.
[6]
Sreenivasan J, Zhuo M, Khan MS, et al. Anemia（hemoglobin≤13 g/dl）as a risk factor for contrast-induced acute kidney injury following coronary angiography [J]. Am J Cardiol, 2018, 122（6）: 961-965.
[7]
Gorla R, Tsagakis K, Horacek M, et al. Impact of preoperative anemia and postoperative hemoglobin drop on the incidence of acute kidney injury and in-hospital mortality in patients with type B acute aortic syndromes undergoing thoracic endovascular aortic repair [J]. Vasc Endovascular Surg, 2017, 51（3）: 131-138.
[8]
Haase-Fielitz A, Haase M, Bellomo R, et al. Perioperative hemodynamic instability and fluid overload are associated with increasing acute kidney injury severity and worse outcome after cardiac surgery [J]. Blood Purif, 2017, 43（4）: 298-308.
[9]
Walsh M, Garg AX, Devereaux PJ, et al. The association between perioperative hemoglobin and acute kidney injury in patients having noncardiac surgery [J]. Anesth Analg, 2013, 117（4）: 924-931.
[10]
Cardinale D, Cosentino N, Moltrasio M, et al. Acute kidney injury after lung cancer surgery: Incidence and clinical relevance, predictors, and role of N-terminal pro B-type natriuretic peptide [J]. Lung Cancer, 2018, 123: 155-159.
[11]
Rungkitwattanakul D, Chaijamorn W, Han E, et al. Kidney function assessment in African American patients: a narrative review for pharmacists [J]. Pharmacy（Basel）, 2022, 10（3）: 65.
[12]
Heyman SN, Khamaisi M, Zorbavel D, et al. Role of hypoxia in renal failure caused by nephrotoxins and hypertonic solutions [J].Semin Nephrol, 2019, 39（6）: 530-542.
[13]
Karkouti K, Grocott HP, Hall R, et al. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study [J]. Can J Anaesth, 2015, 62（4）: 377-384.
[14]
Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment [J]. Nat Rev Nephrol, 2017, 13（11）: 697-711.
[15]
Yuan SM. Acute kidney injury after cardiac surgery: risk factors and novel biomarkers [J]. Braz J Cardiovasc Surg, 2019, 34（3）: 352-360.
[16]
Licker M, Cartier V, Robert J, et al. Risk factors of acute kidney injury according to RIFLE criteria after lung cancer surgery [J].Ann Thorac Surg, 2011, 91（3）: 844-850.
[17]
Ishikawa S, Griesdale DEG, Lohser J. Acute kidney injury after lung resection surgery: incidence and perioperative risk factors [J]. Anesth Analg, 2012, 114（6）: 1256-1262.
[18]
Kavaz A, Ozçakar ZB, Kendirli T, et al. Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria [J]. Acta Paediatr, 2012, 101（3）: e126-e129.
[19]
Schneider J, Khemani R, Grushkin C, et al. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit [J]. Crit Care Med, 2010, 38（3）: 933-939.
[20]
Thomas ME, Blaine C, Dawnay A, et al. The definition of acute kidney injury and its use in practice [J]. Kidney Int, 2015, 87（1）: 62-73.
[21]
Li Q, Zhao M, Wang X. AKI in the very elderly patients without preexisting chronic kidney disease: a comparison of 48-hour window and 7-day window for diagnosing AKI using the KDIGO criteria [J]. Clin Interv Aging, 2018, 13（20）: 1151-1160.
[22]
Kellum JA, Sileanu FE, Murugan R, et al. Classifying AKI by urine output versus serum creatinine level [J]. J Am Soc Nephrol, 2015, 26（9）: 2231-2238.
[23]
Ostermann M, Liu K, Kashani K. Fluid management in acute kidney injury [J]. Chest, 2019, 156（3）: 594-603.
[24]
Horres CR, Adam MA, Sun Z, et al. Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review [J]. Perioper Med（Lond）, 2017, 6: 13.
[25]
Zarbock A, Koyner JL, Hoste EAJ, et al. Update on perioperative acute kidney injury [J]. Anesth Analg, 2018, 127（5）: 1236-1245.
2023年第48卷第6期
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doi: 10.11855/j.issn.0577-7402.2023.06.0694
  • 接收时间：2022-06-15
  • 首发时间：2025-12-03
  • 出版时间：2023-06-28
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  • 收稿日期：2022-06-15
  • 录用日期：2022-07-23
基金
National Key Research and Development Program of China(2018YFC2001800)
国家重点研发计划(2018YFC2001800)
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    北京大学第一医院麻醉科，北京 100034

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孟昭婷，E-mail：
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