慢性肾脏病 3 期行肾部分切除术患者围术期急性肾损伤的危险因素

Risk factors for perioperative acute kidney injury following partial nephrectomy in patients with stage 3 chronic kidney disease

摘要

目的：探讨慢性肾脏病（chronic kidney disease，CKD）3期患者行肾部分切除术后发生急性肾损伤（acutekidney injury，AKI）的危险因素。方法：回顾性分析2013年1月至2025年12月于北京大学第三医院行肾部分切除术的 CKD 3 期患者的临床资料，收集患者人口学特征、合并症、手术相关指标及实验室数据。根据改善全球肾脏病预后组织（Kidney Disease：Improving Global Outcomes，KDIGO）的标准定义术后 AKI。采用单因素和多因素回归分析筛选术后 AKI 的独立危险因素，并通过受试者工作特征（receiver operating characteristic，ROC）曲线确定相关因素的预测截断值。结果：共纳入 126 例 CKD 3 期患者，术后 AKI 发生率为 31.0% (39/126)  。单因素分析显示，AKI组患者机器人手术比例更低（12.8% vs. 33.3%,P=0.018），肾动脉阻断时间更长（25 min vs. 18 min,P<0.001），术中出血量更多（20 mL vs. 50 mL,P=0.028）。多因素 Logistic 回归分析显示，肾动脉阻断时间（$\mathit{O}\mathit{R}=\mathrm{1.105,95}\mathrm{\%}\mathit{C}\mathit{I}:1.041\sim 1.173,\text{ }\mathit{P}=0.001$）和术中出血量（$\mathit{O}\mathit{R}=1.004,\text{ }95\mathrm{\%}\mathit{C}\mathit{I}:1.000\sim 1.007,\text{ }\mathit{P}=0.046$）是术后发生 AKI 的独立危险因素。ROC 曲线分析显示，肾动脉阻断时间预测 AKI 的曲线下面积为 0.737 ，最佳截断值为 18 min ，阻断时间 ⩾18 min 的患者 AKI 发生率显著高于 <18 min 的患者（43.2% vs. 8.8%, P<0.001）。结论：CKD 3 期患者行肾部分切除术后 AKI 发生率较高，肾动脉阻断时间与术中出血量是术后发生 AKI 的独立危险因素，将肾动脉阻断时间控制在 18 min 以内并尽量减少术中出血，有助于降低该高危人群术后 AKI 的风险。

Abstract

Objective：To explore the risk factors for acute kidney injury（AKI）in patients with stage 3 chronic kidney disease（CKD）after partial nephrectomy. Methods：The clinical data of 126 stage 3 CKD patients who underwent partial nephrectomy at Peking University Third Hospital from January 2013 to December 2025 were retrospectively analyzed.Demographic characteristics，comorbidities，surgical-related indicators，and laboratory data of the patients were collected.AKI was defined according to the Kidney Disease：Improving Global Outcomes（KDIGO）criteria.Univariate and multivariate regression analyses were used to identify the independent risk factors for postoperative AKI，and the predictive cutoff value of the receiver operating characteristic（ROC）curve was determined. Results：A total of 126 stage 3 CKD patients were included.The incidence of AKI after surgery was 31.0%（39/126）.Univariate analysis showed that the proportion of robotic surgery was lower in the AKI group（12.8% vs.33.3％， P=0.018），the duration of renal artery occlusion was longer（25 min vs. 18 min,P<0.001），and the intraoperative blood loss was greater（20 mL vs. 50 mL，P=0.028）.Multivariate Logistic regression analysis confirmed that the duration of renal artery occlusion $(\mathit{O}\mathit{R}=\mathrm{1.105,95}\mathrm{\%}\mathit{C}\mathit{I}:1.041-1.173$ ， P=0.001) and intraoperative blood loss $(\mathit{O}\mathit{R}=\mathrm{1.004,95}\mathrm{\%}\mathit{C}\mathit{I}:1.000-1.007,\mathit{P}=0.046)$ were in-dependent risk factors for postoperative AKI.ROC curve analysis showed that the area under the curve for predicting AKI by renal artery occlusion time was 0.737，and the optimal cutoff value was 18 min.The incidence of AKI was significantly higher in the patients with renal artery occlusion time ⩾18 min than those with< 18 min (43.2% vs. 8.8%,P<0.001）. Conclusion：The incidence of AKI after partial nephrectomy in stage 3 CKD patients is relatively high.The duration of renal artery occlusion and intra- operative blood loss are independent risk factors for postoperative AKI.Controlling the renal artery occlu- sion time within 18 min and minimizing intraoperative blood loss can help reduce the risk of AKI in this high-risk population after surgery.

关键词

慢性肾脏病3期 / 肾部分切除术 / 急性肾损伤 / 危险因素 / 肾动脉阻断时间

Key words

Chronic kidney disease stage 3 / Partial nephrectomy / Acute kidney injury / Risk factors / Renal artery occlusion time

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基金资助

北京大学第三医院临床重点项目(BYSYZD2023050)