作者：邝立挺1，陈斌2

单位：1.中山大学附属第一医院 麻醉科， 广东 广州 510080；2.中山大学附属第一医院 肝外科， 广东 广州 510080

Authors: Kuang Liting1，Chen Bin2

Unit: 1.Department of Anesthesiology, the First Afflicted Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China; 2.Department of Liver Surgery, the First Affiliated Hospital, Sun Yat -sen University, Guangzhou 510080，Guangdong，China

摘要：

目的 探讨术前肾功能正常接受肝癌切除术的患者术后急性肾损伤（AKI）的危险因素，为临床相关预防方案的选择及改善患者的预后提供参考。方法 选取2015年1月至2021年12月在中山大学附属第一医院术前肾功能正常接受肝癌切除术的患者1951例，参照2012年改善全球肾脏病预后组织（KDIGO）制订的标准诊断肝癌切除术后AKI的发生情况，入选对象分为AKI组（n=145）和非AKI组（n=1806）。比较AKI组与非AKI组患者的临床特征、术前实验室资料、术中情况、术后实验室资料及临床演变，分析肝癌切除术后继发AKI的危险因素及预后情况。结果 1951例术前肾功能正常接受肝癌切除术的患者术后AKI发生率为7.43%(145/1951)。将单因素分析中P<0.05的自变量行多因素Logistic回归分析，结果显示体重指数、术前合并高血压病、高脂血症、肝硬化、术中低中心静脉压时间延长、术中使用去甲肾上腺素是影响术后AKI发生的独立危险因素。将上述危险因素绘制ROC曲线，并制作术前肾功能正常行肝癌切除术的患者术后发生AKI的Nomogram预测模型。与非AKI组相比，AKI组术后转入重症监护室、需要透析治疗、发生肝衰竭的比例更高，总住院天数和手术后住院天数均延长。结论 术前肾功能正常接受肝癌切除术的患者术后继发AKI与多种术前术中的危险因素密切相关，需要进行更加全面的评估和监测，降低术后AKI的发生率，改善患者的预后。 

关键词：肝癌切除术； 肾功能； 急性肾损伤； 危险因素； 回顾性；预测模型

Abstract：

Objective To explore the risk factors of postoperative acute renal injury（AKI） in patients with normal preoperative renal function undergoing hepatectomy ，which can provide guidance for the selection of clinically relevant prevention schemes and improve the prognosis of patients．Method 1951 patients with normal preoperative renal function who underwent hepateetomy from January 2015 to December 2021 in the First Affiliated Hospital of Sun Yat-sen University were included in the study. The incidence of AKI after hepatectomy was diagnosed according to the KDIGO AKI criteria in 2012．The selected patients were divided into AKI group （n =145） and non -AKI group （n =1806）.The differences of the clinical characteristics，preoperative laboratory data，intraoperative findings，postoperative laboratory data and clinical evolution between patients with AKI and non -AKI group were compared ，and the risk factors and prognosis of postoperative AKI after hepatectomy were analyzed． Result The incidence of AKI after hepatectomy was 7.43%（145/1951） in 1951 patients with normal preoperative renal function．The independent variable of P <0.05 in the univariate analysis was used for multivariate logistic regression analysis. The results showed that body mass index （BMI），preoperative hypertension，hyperlipidemia，liver cirrhosis，prolonged time of intraoperative low central venous pressure，and intraoperative use of norepinephrine were independent risk factors for postoperative AKI. The ROC curve of the above risk factors was drawn，and the Nomogram prediction model of AKI in patients with normal preoperative renal function who underwent hepatectomy was made. Compared with the non -AKI group，the AKI group had a higher proportion of patients who were transferred to ICU，dialysis treatment and liver failure，and the total hospital stay and postoperative hospital stay were prolonged. Conclusion Postoperative AKI is closely related to various preoperative and intraoperative risk factors in patients with normal preoperative renal function undergoing hepatectomy. More comprehensive evaluation and monitoring are needed to reduce the incidence of postoperative AKI and improve the prognosis of patients.

Key Words：Hepatectomy； Renal function； Acute renal injury； Risk factors； Retrospective； Predictive model