【罂粟摘要】术中低体温与全身麻醉下脊柱手术后急性肾损伤减少相关：一项回顾性观察研究
术中低体温与全身麻醉下脊柱手术后急性肾损伤减少相关：一项回顾性观察研究
贵州医科大学 高鸿教授课题组
翻译：唐剑 编辑：佟睿 审校：曹莹
尽管已知低温对缺血性损伤有保护作用，但其对肾脏损伤的影响尚不清楚。因此，本研究旨在确认术中低体温与全麻下脊柱手术患者术后急性肾损伤(AKI)的关系。
方法
在这项回顾性观察研究中，我们分析了2010年1月至2018年3月间接受择期脊柱手术的成年患者的病历。根据术中平均体温将患者分为常温组(36.5~37.5°C)、亚低温组(35~36.5°C)和低温组(<35°C)。，在治疗权重(IPTW)逆概率调整后，采用Logistic回归分析分析术中平均体温与术后AKI发生率之间的关系。
6520例患者中，2 48例(3.8%)在术后3天内确诊为急性肾损伤。经IPTW调整后，亚低温组术后急性肾损伤的发生率比常温组低32%(odds ratio, 0.68; 95%CI, 0.53-0.87; P= 0.002)，而亚低温组术后急性肾损伤的发生率与常温组(P=0.139)和亚低温组(P=0.05)无显著差异(P=0.05)，亚低温组与常温组(P=0.05)和亚低温组(P=0.05)相比无显著性差异(P=0.05)。
本研究表明，术中低体温与全身麻醉下脊柱手术后AKI的发生率降低相关。
Kidney Injury After Spine Surgery Under General Anesthesia: A Retrospective Observational Study.
BACKGROUND: Although hypothermia is known to have protective effects against ischemic injuries, the effects of hypothermia on kidney injury have not yet been elucidated. Therefore, this study aimed to identify the association between intraoperative hypothermia and postoperative acute kidney injury (AKI) in patients who underwent spine surgery under general anesthesia.
METHODS:In this retrospective observational study, we analyzed the medical records of adult patients who underwent elective spine surgery between January 2010 and March 2018. Patients were classified into the normothermia group (36.5 to 37.5°C), mild hypothermia group (35 to 36.5°C), and hypothermia group (<35°C) based on the mean intraoperative temperature, measured using an esophageal stethoscope. The association between mean intraoperative temperature and the incidence of postoperative AKI was analyzed using logistic regression analysis after inverse probability of treatment weighting (IPTW) adjustment.
RESULTS:The analysis included 6520 patients, of whom 248 (3.8%) were diagnosed with AKI within POD 3. After applying IPTW adjustment, the incidence of postoperative AKI was 32% lower in the hypothermia group than in the normothermia group (odds ratio, 0.68; 95% confidence interval, 0.53-0.87; P=0.002), whereas the incidence of postoperative AKI in the mild hypothermia group was not significantly different from that in the normothermia (P=0.139) and hypothermia groups (P=0.075).
CONCLUSIONS:This study showed that intraoperative hypothermia is associated with a reduction in the incidence of AKI following spine surgery under general anesthesia. Further, this association was evident in the group with hypothermia <35°C.