90岁及以上患者手术应激所致肾功能不全及其对生存的影响

S. Kutlusoy, E. Koca, A. Aydın
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引用次数: 0

摘要

背景/目的:已发表的关于90岁及以上患者手术结果的研究大多集中在特定手术上,如髋部骨折。与以往的报道不同,我们的研究包括了我院8年来90岁及以上患者组的所有外科手术。我们的目标是能够通过血浆尿素和肌酸值(术前和术后常规实验室参数)来预测老年人肾脏对手术应激的反应,并预测其对死亡率的影响。方法:回顾性队列研究284例患者,年龄90 ~ 119岁,均行外科手术。根据术前术后肌酐值将患者分为四组:术前术后肌酐1.25 mmol/L RFT-II组;术前肌酐>1.25 mmol/L,术后肌酐>1.25 mmol/L。结果:284例患者中,术后需要重症监护的占62%。95.4%的患者出院,4.6%的患者不存活。RFT-I组患者(68.7%,n=195)术前术后肌酐1.25 mmol/L,术后应激(肌酐1.25 mmol/L)改善,术后护理(肌酐1.25 mmol/L),术后肾功能无改善,围手术期适当补液。结论:我们的研究发现,在我们90岁及以上、生理储备有限的患者组中,由于手术应激,术后尿素和肌酐值升高。然而,已有研究表明,在术后或术前肾功能不全的患者中,适当的补液和术后重症监护治疗可以改善肾功能检查。术后因手术压力引起的肾功能不全发生率较低,且未改变死亡率。
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Renal dysfunction due to surgical stress and its effects on survival in patients aged 90 and over
Background/Aim: Published studies of surgical outcomes in patients aged 90 years and older have mostly focused on specific surgeries such as hip fractures. Unlike previous reports, our study includes all surgical procedures in patient groups aged 90 and over for eight years in our hospital. We aim to be able to predict the responses of an older adult’s kidney due to surgical stress by using the values of plasma urea and creatine, which are preoperative and postoperative routine laboratory parameters, and to predict its effect on mortality. Methods: Our study was conducted as a retrospective cohort study with 284 patients whose ages ranged from 90 to 119 and who had undergone a surgical operation. The patients were divided into four groups according to preoperative and postoperative creatinine values: preoperative and postoperative creatinine <1.25 mmol/L RFT-I group; preoperative creatinine <1.25 mmol/L but postoperative creatinine >1.25 mmol/L RFT-II group; preoperative creatinine >1.25 mmol/L but postoperative creatinine <1.25 mmol/L RFT-III group; and preoperative and postoperative creatinine >1.25 mmol/L RFT-IV group. Results: Of the 284 cases, 62% required intensive care after surgery. While 95.4% of the patients were discharged, 4.6% did not survive. No renal dysfunction was observed in the RFT-I group (68.7%, n=195) (preoperative and postoperative creatinine <1.25 mmol/L). In the RFT-II group (17.6%, n=50), renal dysfunction (creatinine >1.25 mmol/L) developed due to postoperative surgical stress (creatinine <1.25 mmol/L). In patients in the RFT-III group (6%, n=17), preoperative renal dysfunction (creatinine >1.25 mmol/L) improved with postoperative care (creatinine <1.25 mmol/L). In the RFT-IV group (7.7%, n=22), preoperative renal dysfunction (creatinine >1.25 mmol/L) did not improve postoperative renal dysfunction despite appropriate perioperative fluid replacement. Conclusion: Our study observed an increase in postoperative urea and creatinine values due to surgical stress in our patient group aged 90 and over, who had limited physiological reserves. However, it has been shown that improvement in renal function tests can be achieved with appropriate fluid replacement and postoperative intensive care treatment in patients with postoperative or preoperative renal dysfunction. Our rates of postoperative renal dysfunction due to surgical stress were lower and did not change mortality.
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