Kev mob raum mob hnyav tom qab Kev phais mob plab loj heev - Kev Tshawb Fawb Txog Kev Tshawb Fawb Raws Li Cov Ntaub Ntawv Kho Mob
Jun 25, 2023
Abstract
1. Keeb kwm
Mob raum raug mob (AKI) yog ib qho mob hnyav thiab nquag tom qab phais mob hauv kev raug mob lossis cov neeg mob hnyav hauv chav saib xyuas mob hnyav. Peb tsom los kwv yees qhov kev pheej hmoo ntawm AKI tom qab kev phais mob plab mob ceev thiab kev koom tes ntawm AKI thiab 90- hnub tom qab kev tuag.
2. Cov txheej txheem
Hauv qhov kev tshawb nrhiav kev rov qab los no, peb suav nrog cov neeg mob uas tau phais mob plab loj heev ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob, Tsev Kho Mob Tsev Kho Mob Ze Zej Zog, Denmark, txij xyoo 2010 txog 2016. Cov txiaj ntsig tseem ceeb yog qhov tshwm sim ntawm AKI nyob rau hnub tom qab hnub xya (POD7). AKI tau raug txhais raws li cov txheej txheem ntawm Kab Mob Raum: Txhim Kho Ntiaj Teb Kev Ua Haujlwm (KDIGO). Qhov kev pheej hmoo ntawm AKI tau txheeb xyuas nrog ntau qhov sib txawv logistic regression. Kev sib koom ua ke ntawm AKI thiab 90-hnub kev tuag tau raug tshuaj xyuas nrog ntau qhov sib txawv ntawm kev muaj sia nyob.
3. Cov txiaj ntsig
Hauv pawg, 122 ntawm 703 (17.4 feem pua) cov neeg mob phais tau AKI hauv POD7. Ntawm cov no, 82 (67.2 feem pua) muaj AKI theem 1, 26 (21.3 feem pua) muaj AKI theem 2, thiab 14 (11.5 feem pua) muaj AKI theem 3. Tsib caug yim feem pua ntawm cov neeg mob uas tau tsim kho tom qab AKI tau ua hauv thawj zaug. 24 teev ntawm kev phais. Cuaj caum-hnub kev tuag tau nce siab dua hauv cov neeg mob AKI piv nrog cov neeg mob uas tsis muaj AKI (33.6 feem pua) piv rau 40/581 (6.9 feem pua), kho qhov phom sij piv 4.45 (95 feem pua ntawm kev ntseeg siab 2.69–7.39, P.<0.0001)) and rose with increasing KDIGO stage. Pre-existing hypertension and intraoperative peritoneal contamination were independently associated with the risk of AKI.
4. Cov lus xaus
Qhov kev pheej hmoo ntawm AKI yog siab heev tom qab kev phais mob plab loj thiab nws tus kheej cuam tshuam nrog kev pheej hmoo ntawm kev tuag hauv 90 hnub ntawm kev phais.
Ntsiab lus
Kev phais mob plab, mob raum raug mob, Kev kho mob hnyav, mob tom qab phais, phais xwm txheej ceev.
Nyem qhov no kom paub seb cov txiaj ntsig ntawm Cistanche yog dab tsi
Taw qhia
Mob raum raug mob (AKI) yog ib qho mob heev tab sis feem ntau tsis pom muaj teeb meem tom qab kev phais loj [1–3]. Qhov tshwm sim ntawm 22 mus rau 40 feem pua nyob ntawm cov pej xeem thiab hom kev phais [4–6]. Postoperative AKI tau pom tias yuav ua rau muaj kev pheej hmoo ntawm kev mob ntshav qab zib thiab kev tuag hauv cov neeg mob uas tau txais kev phais loj thiab hauv cov neeg mob hnyav hauv chav saib xyuas mob hnyav [1, 2]. Lub pathophysiology ntawm AKI txog kev phais tsis tau nkag siab tag nrho, ua rau nws nyuaj rau kev tiv thaiv. Ischemia, o, oxidative kev nyuaj siab, thiab noob caj noob ces tej zaum yuav yog lub hauv paus tseem ceeb nyob rau hauv lub pathophysiology ntawm postoperative AKI [7, 8]. Cov kev pheej hmoo ntawm kev kho mob muaj xws li mob raum ua ntej, mob ntshav qab zib, hnub nyoog siab, thiab kub siab [2, 5, 6, 9]. Ntau lub tshuab sib txawv rau kev faib tawm thiab kev kuaj mob ntawm AKI tau qhia ntau xyoo. Niaj hnub no, cov txheej txheem tseem ceeb tshaj plaws yog Kab Mob Raum: Txhim Kho Ntiaj Teb Kev Ua Haujlwm (KDIGO)-cov txheej txheem [10], qhov twg AKI txhais tau tias yog qhov txo qis hauv lub raum ua haujlwm thiab AKI tuaj yeem kuaj pom tias nce qib s-creatinine thiab txo cov zis. cov zis [11].
Qhov kev pheej hmoo ntawm cov teeb meem tom qab kev phais thiab kev mob tshwm sim tom qab yog siab heev hauv cov neeg mob uas tau txais kev phais mob plab loj [12, 13]. Ob peb lub cev raug cuam tshuam los ntawm lub hauv paus pathology thiab kev phais kev ntxhov siab ua rau muaj kev pheej hmoo siab ntawm perioperative ib leeg thiab ntau lub cev tsis ua haujlwm [14]. Yog li ntawd, cov thawj coj hauv tebchaws thiab cheeb tsam tau siv nyob rau xyoo tas los no los txhim kho cov txiaj ntsig kev kho mob rau cov neeg phais tshwj xeeb no [15–17]. Qhov txaus ntshai thiab qhov tshwm sim ntawm AKI tau paub zoo tom qab kev phais mob loj thiab hauv cov neeg mob phais mob hnyav hauv chav saib xyuas mob hnyav, txawm li cas los xij, tsis muaj qhov tshwj xeeb tsom rau AKI tom qab kev phais mob plab loj uas feem ntau ntawm cov neeg mob tau kho nyob rau hauv dav dav. phais tsev kho mob postoperatively.
Qhov kev tshawb fawb rov qab los ntawm kev tshawb fawb no tsom los kwv yees qhov kev pheej hmoo ntawm AKI tom qab kev phais mob plab loj thiab tshuaj xyuas seb AKI puas cuam tshuam nrog 90- hnub tom qab kev tuag tom qab kev phais mob xwm txheej ceev.
Cistanche hmoov
Cov txheej txheem
1. Kawm tsim thiab teeb tsa
Peb tau ua ib txoj kev tshawb fawb rov qab los qhia raws li Te Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement [18]. Peb suav nrog cov neeg mob uas tau txais kev phais mob plab loj heev ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob, Tsev Kho Mob Tsev Kho Mob Ze Zej Zog (Denmark) txij lub Ib Hlis 2010 txog Lub Cuaj Hli 2016. Txoj kev tshawb fawb tau pom zoo los ntawm Danish Data Protection Agency (kev pom zoo: REG-010–2017) . Hauv Denmark, sau ntawv tso cai pom zoo thiab kev pom zoo rau kev ncaj ncees yog los ntawm txoj cai tsis tsim nyog rau kev tshawb fawb txog kev rov qab los. Cov neeg sau ntawv tau nkag mus rau tag nrho cov ntaub ntawv.
2. Kawm cov pej xeem
Tag nrho cov neeg mob uas muaj hnub nyoog 18 xyoo raug xwm txheej kub ntxhov loj (hauv 72 teev tom qab nkag) kev phais plab tau suav nrog. Cov txheej txheem phais uas muaj lub plab, me lossis loj plob tsis so tswj, los yog lub qhov quav rau tej yam kev mob xws li perforation, ischemia, plab abscess, los ntshav los yog obstructive, ntxuav tawm / tshem tawm ntawm intra-peritoneal hematoma los yog abscess, laparotomy / laparoscopy nrog inoperable pathology (xws li, peritoneal / hepatic metastases), adhesiolysis, fascial dehiscence lossis ib qho kev rov ua haujlwm raws li cov txheej txheem saum toj no suav nrog. Laparoscopic thiab cov txheej txheem qhib tau suav nrog yog tias ua raws li cov txheej txheem txheej txheem. Cov neeg mob uas tom qab tau txais ntau txoj kev phais mob tau tsim nyog suav nrog yog tias cov txheej txheem tseem ceeb suav nrog. Cov neeg mob uas tau txais cov txheej txheem plab me me (appendectomy thiab cholecystectomy) raws li txoj kev phais ib leeg tau raug cais tawm. Kev phais mob raug tshem tawm vim qhov sib txawv ntawm pathophysiology. Cov kab mob hauv lub raum kawg nrog kev lim ntshav lossis hloov lub raum tsis yog qhov kev cais tawm.
AKI tau txhais raws li KDIGO cov txheej txheem [10]. Lub hauv paus theem s-creatinine tau txhais tias yog qib s-creatinine thaum nkag. Yog tias muaj ntau qhov txiaj ntsig ua ntej muaj los ntawm kev nkag mus rau hnub ntawm kev phais, tus nqi siab tshaj plaws tau raug xaiv los ua qhov pib. Cov neeg mob uas tsis muaj tus nqi creatinine ua ntej lossis tom qab phais tas. Tom qab phais tas, cov neeg mob tau raug xa mus rau qhov chaw phais mob. Txawm li cas los xij, cov neeg mob xav tau kev pab ua pa los yog lub plawv dhia ncaj qha mus rau ICU. Qhov kev txiav txim siab no tau ua los ntawm tus kws kho mob tshuaj loog thiab / lossis tus kws phais mob.
Raws li tus qauv, txhua tus neeg mob tau txais kev txhaj tshuaj piperacillin-tazobactam nyob rau hnub tom qab kev phais ib mus rau peb. Tsuas yog cov neeg mob uas tau mus rau hauv chav saib xyuas mob hnyav tom qab phais mob tau kho nrog cov tshuaj vasoactive.
3. Kev sau cov ntaub ntawv
Retrospectively, cov neeg mob tau suav nrog siv NOMESCO-raws li cov txheej txheem cov cai. Tag nrho cov ntaub ntawv tus neeg mob tau sau los ntawm cov ntaub ntawv tus neeg mob hauv hluav taws xob. Qhov no suav nrog: Cov neeg mob pej xeem, cov ntaub ntawv ua ntej, intra-, thiab tom qab kev ua haujlwm, American Association of Anaesthesiologists faib (ASA kev faib tawm), WHO tus qhab nia ua tau zoo, Kev ntsuam xyuas sai Sequential Organ Failure Assessment (qSOFA) ntawm kev nkag, thiab cov ntaub ntawv biochemical (s-creatinine, kwv yees glomerular filtration rate (eGFR), ntshav urea, p-hemoglobin, p-sodium, p-potassium). Cov kws tshawb nrhiav tau suav cov Charlson Comorbidity Index (CCI) [19] raws li ICD cov lej muaj nyob rau hauv cov ntaub ntawv tus neeg mob hauv hluav taws xob. Cov kws tshawb nrhiav tau soj ntsuam cov teeb meem phais mob los ntawm Clavien-Dindo qhab nia.
Hauv Denmark, cov xwm txheej tseem ceeb ntawm txhua tus pej xeem tau sau npe hauv Danish Civil Registration System. Daim ntawv teev npe hauv tebchaws no tau txuas nrog cov ntaub ntawv tus neeg mob hauv hluav taws xob. Cov ntaub ntawv ntawm 90-hnub tuag tau muab rho tawm los ntawm cov ntaub ntawv tus neeg mob hauv hluav taws xob.
Cistanche tubulosa
4. Cov txiaj ntsig
Qhov txiaj ntsig tseem ceeb yog qhov tshwm sim tom qab kev phais AKI hauv xya hnub ntawm kev phais. Tsis tas li ntawd, theem ntawm AKI tau ua theem los ntawm 1 txog 3. Postoperative AKI Theem 1 yog raws li KDIGO cov qauv [10] txhais tau tias yog 1.5–1.9-fold nce qib s-creatinine. los ntawm lub hauv paus los yog qhov tseeb 26.5 µmol l −1 nce qib s-creatinine thoob plaws hauv 48 teev lossis tsawg dua li ntawm xya hnub ntawm kev phais. AKI Theem 2 tau txhais tias yog 2.0–2.{18}}fold nce hauv postoperative s-creatinine, thiab AKI Theem 3 yog ntau dua los yog sib npaug rau peb npaug ntawm kev ua haujlwm tom qab s-creatinine los ntawm cov hauv paus lossis qhov nce ntxiv hauv s -creatinine rau ntau dua lossis sib npaug ntawm 353.6 µmol l −1, ob qho tib si thoob plaws 48 h lossis tsawg dua li ntawm xya hnub ntawm kev phais. binary thawj qhov tshwm sim, tom qab kev phais AKI, raws li tau hais los ntawm thawj qhov nce siab s-creatinine raws li KDIGO txhais tau hais tias thoob plaws 48 h lossis tsawg dua nyob rau hauv xya hnub ntawm kev phais, qhov kev muab qhab nia ntawm AKI (1-3) yog raws li qhov loj tshaj plaws nce hauv s-creatinine thoob plaws hauv 48-h lossis tsawg dua li ntawm xya hnub ntawm kev phais. Cov txiaj ntsig thib ob suav nrog 90-hnub tuag, chav saib xyuas mob hnyav (ICU) nkag, qhov ntev ntawm kev nyob, thiab kev phais mob uas tau txiav txim siab raws li qhov qhab nia Clavien-Dindo Ntau dua lossis sib npaug rau 3 [20].
5. Kev txheeb cais
Cov pejxeem tau stratified rau cov neeg mob uas muaj thiab tsis muaj AKI (Ntau dua lossis sib npaug rau KDIGO theem 1). Kev faib tawm cov ntaub ntawv tau tshuaj xyuas nrog histograms thiab QQ cov phiaj xwm. Cov ntaub ntawv txuas ntxiv tau nthuav tawm raws li txhais tau tias nrog tus qauv sib txawv (SD) lossis nruab nrab nrog qhov sib txawv (IQR). Categorical cov ntaub ntawv tau nthuav tawm raws li proportions thiab feem pua. Categorical cov ntaub ntawv tau txheeb xyuas siv χ [2]-test los yog Fischer qhov kev xeem raws li qhov tsim nyog. Cov ntaub ntawv txuas ntxiv tau raug tshuaj xyuas siv tus tub ntxhais kawm qhov kev xeem t-test lossis kev xeem Mann–Whitney U. Qhov sib txawv ntawm s-creatinine dhau lub sij hawm stratified ntawm AKI tau soj ntsuam nrog cov qauv sib xyaw nrog cov qauv tsis sib txawv-cov qauv sib txawv. Peb tau ua ib qho kev sib txawv ntawm cov logistic regression los ntawm kev yuam kev nkag los txheeb xyuas qhov sib txawv uas cuam tshuam nrog kev pheej hmoo ntawm kev ua haujlwm tom qab AKI. Cov kev hloov pauv uas tau hais tseg ua ntej suav nrog hnub nyoog, poj niam txiv neej, cov qhab nia ua tau zoo, lub plawv tsis ua haujlwm, lub hauv paus s-creatinine, kub siab, ntshav qab zib, kab mob peritoneal, cov ntshav tsis ua haujlwm, thiab qSOFA. Cov kev hloov pauv tau raug xaiv los ntawm kev soj ntsuam cov kev xav thiab cov kev tshawb fawb yav dhau los ntawm postoperative AKI [21–23]. Cov txiaj ntsig tau qhia tias tsis hloov kho thiab hloov pauv qhov sib txawv (OR) nrog 95 feem pua ntawm kev ntseeg siab (95 feem pua CI). Qhov kev sim ntawm tus qauv tau sim nrog Hosmer thiab Lemeshow Goodness of Fit test. Uni- thiab multivariable survival tsom xam ntawm kev koom tes ntawm AKI thiab 90- hnub tom qab kev tuag tuag tau ua. Cov kev hloov pauv ua ntej suav nrog hauv kev tshuaj xyuas: AKI, lub hauv paus s-creatinine, pawg hnub nyoog, poj niam txiv neej, CCI, hom kev phais, kev kis kab mob hauv lub cev, thiab qSOFA. Tus qauv tau hloov kho rau lub sijhawm tsis txawj tuag tsis txawj hloov. Kev soj ntsuam ciaj sia tau ua tiav qhov kev xav tias muaj kev phom sij. Cov txiaj ntsig tau qhia tias tsis kho thiab hloov kho qhov phom sij (HR) nrog 95 feem pua CI. Nyob rau hauv ntau qhov sib txawv logistic regression thiab kev txheeb xyuas kev muaj sia nyob ntau qhov sib txawv, qhov siab tshaj plaws ntawm 1 qhov sib txawv ntawm 10 cov xwm txheej tau suav nrog kom tsis txhob muaj tus qauv ntau dhau. Kev txheeb xyuas tau ua nyob rau hauv SPSS statistical Software version 25. IBM. USA thiab SAS version 9.4 (SAS Institute, USA). Qhov ob-sided P-tus nqi <0.05 tau suav tias yog qhov tseem ceeb.
Standardized Cistanche
Kev sib tham
Hauv qhov kev tshawb fawb rov qab los no, peb pom tias 122/703 (17.4 feem pua) ntawm cov neeg mob tau txais kev phais mob plab loj heev tsim AKI hauv xya hnub ntawm kev phais. AKI feem ntau tshwm sim nyob rau hauv 24 teev ntawm kev phais thiab tsuas yog ib ntawm ob tus neeg mob uas AKI tau muaj qib s-creatinine nyob rau hnub xya tom qab kev phais. AKI tau raug cuam tshuam nrog kev pheej hmoo siab ntawm 90-hnub tuag. Kev muaj hnub nyoog nce ntxiv, kev kub siab dhau los, thiab kev sib kis ntawm cov kab mob peritoneal tau ua rau nws tus kheej cuam tshuam nrog kev pheej hmoo ntawm AKI tom qab phais.
Hauv kev phais xaiv, qhov tshwm sim ntawm AKI yog li ntawm 5.3 feem pua rau 6.3 feem pua [24, 25]. Qhov no yog qhov qis dua qhov tshwm sim ntawm AKI hauv peb pawg ntawm cov neeg mob uas muaj kev pheej hmoo siab phais. Peb pom tias cov neeg mob uas tsim AKI laus dua, muaj ntau dua s-creatinine thiab ntshav urea thaum nkag, thiab feem ntau raug kev kub ntxhov thiab ntshav qab zib. Cov kev tshawb pom no qhia tias cov neeg mob uas tsim AKI tom qab qhov kev phais mob plab loj heev ua ntej kev phais tau muaj kev cuam tshuam rau lub raum, txawm li cas los xij, tsis yog mus rau qhov chaw uas qhov no tau ua qhov tseem ceeb hauv kev kho mob. Tsis tas li ntawd, intraoperative intraperitoneal kab mob loj heev yog ib qho kev pheej hmoo rau kev loj hlob ntawm AKI. Qhov no taw tes rau ib qho septic thiab inflammatory Cheebtsam noj. Lub pathophysiology ntawm postoperative AKI yog complex thiab multifactorial [26]. Cov laj thawj ncaj qha tau ntseeg tias yog lub raum hypoperfusion, ischemia, thiab o [25, 27], tag nrho cov no tuaj yeem tshwm sim los ntawm kev phais kev ntxhov siab thiab sepsis [28, 29]. Yog li ntawd, cov neeg mob uas tsim AKI muaj qhov qhab nia qSOFA ntau dua ntawm kev lees paub qhia tias sepsis yuav yog ib qho ntawm cov neeg tseem ceeb hauv cov neeg no. Txawm li cas los xij, qhov kev soj ntsuam ntawm peb txoj kev tshawb fawb tsis tso cai rau kev txiav txim siab txog kev sib raug zoo ntawm kev sib raug zoo.
Cov kua dej sib npaug yog qhov tseem ceeb rau lub raum perfusion thiab cuam tshuam loj heev hauv cov neeg mob uas muaj kab mob sepsis thiab plab pathology xws li mob plab me me [30, 31]. Perioperative kua, kev tswj hemodynamic, thiab kev pheej hmoo ntawm AKI yog cov ntsiab lus sib cav ntau hauv cov tshuaj perioperative [32]. Ib qho loj multicentre randomized soj ntsuam kev sim ntawm kev txwv piv rau liberal kua therapy nyob rau hauv loj elective plab hnyuv phais pom qhov tshwm sim ntawm AKI, raum hloov kho, thiab phais qhov chaw kis tau tus mob yuav txo tau nyob rau hauv lub liberal kua pab pawg neeg piv nrog cov txwv [33]. Lwm cov kev tshawb fawb tau tshuaj xyuas kev siv ib thiab tom qab lub hom phiaj ntawm kev kho cov kua dej, intraoperative standardized tswj ntawm hypotension, thiab tsom oliguria reversal raws li cov tswv yim los tiv thaiv AKI [34-36]. Txawm li cas los xij, cov txiaj ntsig ntawm cov tswv yim no los tiv thaiv AKI tseem tab tom sib cav. Hauv peb pawg neeg, kev tswj xyuas cov kua dej perioperative tsis yog tus qauv, thiab cov hom phiaj qhia cov kua dej tsis tau siv.
Hauv peb txoj kev tshawb fawb, peb pom tias tom qab kev phais AKI yog nws tus kheej cuam tshuam nrog tag nrho 90-hnub tuag. Qhov no lees paub qhov kev tshawb pom los ntawm cov kev tshawb fawb yav dhau los ntawm cov neeg mob uas tsis yog phais mob plawv [2, 6]. Nws yog ib qho tseem ceeb uas yuav tau txiav txim siab seb AKI puas yog qhov ua rau tuag lossis yog AKI yog qhov tshwm sim thiab qhov tshwm sim ntawm qhov mob hnyav hnyav ua rau muaj kev ua haujlwm ib leeg thiab ntau lub cev. Peb pom tias yuav luag 60 feem pua ntawm cov neeg mob uas tsim AKI tau ua li ntawd hauv thawj 24 teev ntawm kev phais. AKI tej zaum yuav raug siv los ua tus cim ntxov ntawm cov kab mob hauv nruab nrog cev lossis kev phais mob. Tus nqi kwv yees ntawm AKI yuav tsum tau lees paub hauv kev tshawb fawb yav tom ntej.
Hauv peb txoj kev tshawb fawb, peb pom tias tsuas yog 48 feem pua ntawm cov neeg mob AKI tau normalize s-creatinine qib hauv xya hnub ntawm kev phais. Nws yog qhov tsim nyog los txiav txim siab seb lub sijhawm luv luv tom qab AKI tuaj yeem ua rau mob raum mob [37]. Ib txoj kev tshawb fawb nrog rau 390 tus neeg mob uas tau txais kev kho mob ceev lossis xaiv qhov loj tsis yog vascular phais plab pom tau tias 47 feem pua ntawm cov neeg mob uas tau tsim kho tom qab AKI tau ntsib qhov tsis zoo rau lub raum mus ntev (P<0.0001), defined as the need for long-term dialysis and/or a 25% decrease in eGFR after hospital discharge [38]. Thus, even if AKI is a consequence of underlying acute illness, it may also be associated with long-term adverse outcomes.
Cistanche ntsiav tshuaj
Muaj zog thiab kev txwv
Txoj kev tshawb no txwv los ntawm nws qhov kev soj ntsuam qhov ua rau muaj kev pheej hmoo rau qhov seem ntawm qhov tsis sib haum xeeb. Cov neeg mob uas muaj peev xwm tsim nyog tau raug tshem tawm vim tsis muaj cov theem pib s-creatinine. Qhov no tuaj yeem ua rau muaj kev cuam tshuam kev xaiv; Txawm li cas los xij, peb tsis tuaj yeem txheeb xyuas qhov laj thawj uas tuaj yeem piav qhia cov ntaub ntawv ploj lawm. Baseline s-creatinine tau txhais tias yog qhov kev ntsuam xyuas nkag. Muaj peev xwm, kev nkag mus ntawm s-creatinine tuaj yeem nce siab ua rau muaj kev pheej hmoo ntawm kev kwv yees tag nrho (ua ntej thiab tom qab phais) tshwm sim ntawm AKI. Txawm li cas los xij, qhov tseem ceeb ntawm txoj kev tshawb no yog los kwv yees cov txiaj ntsig ntawm cov txheej txheem phais nrog rau kev phais kev ntxhov siab rau kev pheej hmoo ntawm AKI, yog li ntawd, qhov sib txawv ntawm s-creatinine ua ntej kev phais tom qab phais yog thawj qhov kev ntsuam xyuas ntawm kev txaus siab. Peb xaiv qhov siab tshaj plaws preoperative s-creatinine tus nqi raws li cov hauv paus ntsiab lus yog tias muaj ntau yam txiaj ntsig kom paub tseeb tias tsis suav nrog cov neeg mob uas muaj ib qho kev ua ntej AKI. Cov neeg mob tau raug txiav txim siab tias muaj AKI tom qab phais yog tias lawv ua tau raws li KDIGO cov txheej txheem tom qab kev phais txawm tias qhov kev puas tsuaj pib ua ntej lossis tom qab kev phais. Peb tsis tuaj yeem tawm tswv yim seb tus neeg mob puas muaj AKI thaum nkag. Ntxiv mus, peb tau siv KDIGO Cov Lus Qhia txhawm rau txheeb xyuas cov xwm txheej ntawm AKI tom qab ua haujlwm hauv pawg. Txawm li cas los xij, peb tsis tuaj yeem nkag mus rau cov ntaub ntawv tso zis tso zis, thiab tej zaum peb yuav tau plam qee kis ntawm AKI. Txoj kev tshawb no tau txwv los ntawm nws qhov kev tsim ib-nruab nrab thiab cov txiaj ntsig yuav tsis tuaj yeem ua tau. Cov txiaj ntsig yuav tsum tau lees paub hauv cov pej xeem loj nrog rau ntau lub chaw. Raws li cov ntaub ntawv kho mob hluav taws xob, 4.3 feem pua ntawm cov pej xeem muaj kab mob raum ntev. Feem ntau ntawm cov kab mob raum ntev hauv lwm lub tebchaws nyob sab Europe tau kwv yees li 5.4-6.2 feem pua thiab siab dua ntawm cov neeg laus thiab cov neeg muaj ntshav siab, ntshav qab zib, lossis kab mob plawv [39–41]. Ib feem tseem ceeb ntawm cov neeg mob hauv peb txoj kev tshawb fawb yuav muaj cov kab mob raum tsis zoo vim tias ntau tus neeg laus muaj ntshav siab lossis ntshav qab zib. Yog li ntawd, cov kab mob raum ntev raws li qhov muaj feem cuam tshuam rau mob raum raug mob tsis tuaj yeem ntsuas qhov tseeb hauv txoj kev tshawb no. Lwm qhov kev txwv yog qhov tsis muaj tus qauv ntawm kev tswj hwm cov kua dej perioperative hauv pawg neeg thiab qhov tseeb tias lub hom phiaj qhia cov kua dej tsis siv. Tsis tas li ntawd, peb tsis muaj cov ntaub ntawv hais txog kev ua haujlwm hypotension. Txoj kev tshawb no tau tshaj tawm raws li cov txheej txheem thoob ntiaj teb thiab txhua qhov kev tshuaj ntsuam tau raug txhais ua ntej suav nrog cov kev hloov pauv hauv kev ntsuas ntau yam.
Cov lus xaus
Hauv kev xaus, ib ntawm tsib tus neeg mob tau ua haujlwm tom qab AKI tom qab kev phais mob plab mob hnyav thiab AKI tshwm sim nyob rau ob peb hnub ntawm txoj kev phais. Lub xub ntiag ntawm AKI ua rau muaj kev pheej hmoo tuag hauv 90 hnub ntawm kev phais. Lub pathophysiology ntawm AKI yuav tsum tau kawm ntxiv los tsim cov tswv yim tiv thaiv perioperative.
Cov ntaub ntawv
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Theis B. Mikkelsen, Anders Schack, Jakob O. Oreskov, Ismail Gögenur, Jakob Burcharth thiab Sarah Ekeloef
