Incidence And Risk F Actors Of Acute Kidney Injury In Department Of Neurosurgery Under Different Anesthesia Methods

Objective: Acute kidney injury(AKI)is a syndrome that clinically and suddenly occurs and causes intense kidney function compromise within a short time(from several hours to several days)due to various causes.When the disease occurs,the kidney function can deteriorate rapidly in a few hours or within a few days,the ability of the kidney to discharge nitrogen metabolism waste will suddenly and seriously reduced or even lost,in vivo water,electrolyte and acid-base balance all will be a serious disorder.If timely treatment can not be taken,it will seriously affect the long-term mortality and prognosis of patients.Surgeries are often a predisposing factor for AKI,such as kidney damage caused by contrast agents,renal injury after sepsis,renal injury after cardiac operation,but there is little researches on renal injury after neurosurgical operation.The length of neurosurgical operation and the sensitive locations of operation are easy to cause neurogenic kidney injury.In addition,the acute craniocerebral trauma,cerebral hemorrhage,brain edema as well as the different anesthetic methods and anesthetic drugs during operation all have different effects on renal function.This study is divided into two parts,the first part is a retrospective collection of neurosurgicall patients’ data and the analysis on the incidence of their postoperatively-occurred AKI and the risk factors responsible for the occurrence of AKI,so as to provide a basis for clinical early prevention and treatment;the second part is based on the content of serum neutrophil NGAL and the change of preoperative creatinine and postoperative creatinine.By the comparison on the effect of propofol,sevoflurane and desflurane anesthesia on the incidence of AKI after neurosurgical operations,the safety of different anesthetic methods used in neurosurgical operations was evaluated,which was helpful for preoperative AKI risk assessment of neurosurgical patients.Methods:1)To retrospectively analyze the risk factors of AKI after neurosurgical operations under total intravenous anesthesia.A collection of clinical data was made on 200 neurosurgical patients in the General Hospital of Tianjin Medical University from January 2016 to December 2016.Inclusion criteria: the blood electrolyte,creatinine,urine routine and urea nitrogen were in normal range when being admitted to the hospital;no previous history of basic renal disease and cardiac insufficiency.Exclusion criteria: Patients with basic renal diseases,ages < 18 years old or > 70 years old as well as pregnant women.An retrospective collection was made on the clinical data of the included cases of patients,and the clinical data of these patients with AKI were summarized,including: gender,age,hospitalization time,primary diseases,concurrent diseases,preoperative creatinine,preoperative urea nitrogen,preoperative glomerular filtration rate,GCS score at the entry of operation room,operation time,anesthesia time,blood pressure and heart rate at the entry of operation room,intraoperative minimum blood pressure and the slowest heart rate,the postoperative blood pressure and heart rate when returning to ward,intraoperative transfusion volume,intraoperative infusion volume,intraoperative arterial blood lactate value(the highest value of lactic acid in intraoperative blood gas analysis),postoperative 24 h creatinine,postoperative 24h-urea nitrogen,postoperative 24 h urine volume and postoperative 24 h input and output volume.According to the absence or presence of the occurrence of AKI,these patients were divided into Acute Kidney Injury Group(positive group)and AKI-absence Group(control group).The single factor analysis was used firstly,the logistic regression analysis was used in multifactor analysis.Then it analyzed the risk factors of acute renal injury in these patients.2)The effects of propofol,sevoflurane and desflurane anesthesia on the serum NGAL and the incidence of AKI in patients who underwent neurosurgical operations.The clinical data of 60 cases of selected patients with neurosurgical surgery were collected,and their operation time lengths were more than 3 hours.Inclusion criteria: the blood electrolyte,creatinine,urine routine and urea nitrogen were in normal range when being admitted to the hospital;no previous history of basic renal disease and cardiac insufficiency.Exclusion criteria: Patients with basic renal diseases,ages < 18 years old or > 70 years old as well as pregnant women.These patients were randomly divided into 3 groups(n=20): propofol intravenous anesthesia group(P Group),sevoflurane inhalation Group(S Group)and desflurane inhalation group(D Group).The methods of anesthesia induction were the same in three groups.Patients in P Group were continuously pumped with propofol to maintain a certain depth of anesthesia,these patients in S Group and D Group were respectively and continuously pumped with sevoflurane and desflurane to maintain a certain depth of anesthesia.In the three groups,the average arterial pressure(MAP)and heart rate(HR)were maintained as the basal level ±20%.Indicators recording: the preoperative creatinine,postoperative 24 h and 48 h of creatinine were recorded,and ELISA assay was used to determine the content of the NGAL in preoperative,postoperative 24 h and 48 h of blood of these patients after operation.According to the indicators,it determined whether there is an occurrence of AKI,so as to evaluate the effects of different anesthetic drugs(propofol,sevoflurane and desflurane)on the incidence of AKI in these patients after operation and the reliability of these anesthesia methods.Results: 1.The incidence of AKI in the Department of neurosurgery was 8.5%.The postoperative urea,postoperative creatinine,preoperative uric acid,postoperative uric acid,intraoperative arterial blood lactic acid,GCS score,and preoperative glomerular filtration rate in the experimental group was statistically significant difference(P < 0.05)in comparison with control group.Logistic regression analysis showed that intraoperative blood lactic acid value and preoperative glomerular filtration rate were independently associated with AKI in neurosurgical patients(P < 0.05).2.The patients in P Group,S Group and D Group were treated with three different anesthetic methods,but the effects of these methods on the concentration of NGAL in the blood of neurosurgical patients have no significant difference(P > 0.05),there was no significant difference in creatinine between the three groups before and after operation(P > 0.05),and there was no difference for the incidence of postoperative AKI in these three groups(P > 0.05).Conclusion:1.The intraoperative arterial blood lactate value and preoperative glomerular filtration rate are the independent risk factors of AKI in neurosurgical patients under total intravenous anesthesia,and are able to provide a reference for the prevention and treatment of perioperative renal injury in neurosurgical operations.2.The patients in Propofol intravenous anesthesia group,sevoflurane inhalation group and desflurane inhalation group did not cause AKI after operation in department of neurosurgery.There was no difference in the early blood NGAL content and Scr value in the patients after operation,and they can be safely used for long time Department of neurosurgery operations.