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目的:提高对腹腔镜根治性膀胱切除(laparoscopic radical cystectomy,LRC)术后并发急性肾损伤(acute kidney injure,AKI)的认识和防治水平。方法:通过病例分析及文献研究,探讨LRC术后AKI患者的危险因素及预防治疗措施。结果:2例患者行LRC术后1周并发3级AKI。经过针对原发诱因及连续肾脏替代(continuous renal replacement therapy,CRRT)治疗,约3~4周后肌酐稳定,发展至轻中度慢性肾脏病。结论:LRC术后AKI发生是综合因素的结果。LRC术后发生AKI高危风险因素包括高龄、复杂手术、长时间手术、基础疾病多等,其中女性、高血压、既往慢性肾脏病史、IV级以上的ASA麻醉分级、既往手术史均为腹部手术后AKI发生的独立危险因素。围手术期针对腹腔高压(intra-abdominal hypertension,IAH)、感染等高危因素的积极主动处理有利于预防AKI的发生。推荐早期CRRT治疗,能取得较好预后。
Objective: To improve the understanding and prevention of acute kidney injure (AKI) after laparoscopic radical cystectomy (LRC). Methods: To analyze the risk factors and prevention and treatment measures of AKI patients after LRC by case analysis and literature research. Results: Two patients had grade 3 AKI one week after LRC. After about 3 to 4 weeks of treatment for primary causes and continuous renal replacement therapy (CRRT), creatinine was stable and progressed to mild to moderate chronic kidney disease. Conclusion: The occurrence of AKI after LRC is the result of comprehensive factors. The risk factors of AKI after LRC include high age, complicated operation, prolonged operation and multiple underlying diseases. Among them, the history of female, hypertension, previous chronic kidney disease, ASA anesthesia grade IV or above, and the history of previous surgery are all postoperative abdominal surgery AKI independent risk factors. Perioperative period for active treatment of high-risk factors such as intra-abdominal hypertension (IAH), infection is conducive to the prevention of AKI. Recommended early CRRT treatment, can achieve better prognosis.