Ameliyat Sonrası Yoğun Bakım Ünitesinde (PACU) Böbrek Hasarı Sıklığının Değerlendirilmesi: Prospektif Gözlemsel Bir Çalışma

Yıl 2024, Cilt: 38 Sayı: 3, 201 - 213, 27.12.2024

Farid Hajili Volkan Hancı , Şule Özbilgin , Pınar Ayvat , Dilek Ömür Arça , Erol Gökel

https://doi.org/10.18614/deutip.1443212

Öz

Giriş: Bu çalışmada postoperatif yoğun bakım ünitesinde tedavi edilen cerrahi olgularda postoperatif dönemde, postoperatif akut böbrek hasarı (ABH) sıklığı, ABH ile ilişkili faktörler ve ABH'nin sonuçlar üzerine etkisi araştırılmıştır.
Gereç ve Yöntem: Bu çalışma prospektif ve gözlemsel bir çalışmadır. Çalışmamıza postoperatif dönemde PACU'da tedavi edilen cerrahi vakalar dahil edilmiştir. Hastaların demografik özellikleri, ameliyat ve anestezi özellikleri, Charlson Komorbidite İndeksi (CCI) değerleri, Amerikan Anesteziyoloji Derneği (ASA) risk sınıfları, ameliyat öncesi biyokimya sonuçları ve ameliyat öncesi hemogram sonuçları kaydedildi. Hastaların AKI'si Risk, Yaralanma, Başarısızlık, Fonksiyon Kaybı ve Son Dönem Böbrek Hastalığı (RIFLE) ve Akut Böbrek Hasarı Ağı (AKIN) kriterleri kullanılarak değerlendirildi.
Bulgular: Çalışmamızda postoperatif erken dönemde böbrek hasarlanması sıklığı %17,7 olarak belirlendi. Yaş, preoperatif CCI, BUN, GFR, kalsiyum, total bilüribün değerleri, preoperatif peptik ulkus öyküsü, operasyonun aciliyeti, intraoperatif kan ve kolloid kullanım sıklığı, PACU'da kristaloid ve TDP miktarı, PACU'da kolloid kullanımı sıklığı ile postoperatif akut böbrek hasarı arasında ilişki bulunduğu belirlenmiştir (p<0.05). Postoperatif böbrek hasarı gelişen olgularda PACU'da inotrop kullanım sıklığı, invaziv mekanik ventilatör kullanım sıklığı ve süresi, PACU yatış süresinin arttığı, kardiyak komplikasyon, aritmi, atrial fibrilasyon, solunum sistemi komplikasyonları, sepsis, nörolojik komplikasyonlar, postoperatif deliryum ve mortalite sıklığının yükseldiği belirlenmiştir (p<0.05).
Sonuç: Postoperatif yoğun bakım ünitesinde takip edilen olgularda erken dönemde böbrek hasarlanması sıklığı %17,7 olarak belirlenmiştir. Yaş, CCI, BUN, GFR, kalsiyum, bilirubin değerleri ve ameliyatın aciliyeti ile postoperatif AKI arasında ilişki olduğu tespit edilmiştir. Postoperatif dönemde AKI gelişimi artmış morbidite ve mortalite ile ilişkilidir.

Anahtar Kelimeler

Akut böbrek yetersizliği, Postoperatif, PACU, Yoğun Bakım

Etik Beyan

Non-Invasive Ethics Committee of Dokuz Eylul University Medical Faculty (Ethics Committee Decision dated 08.02.2021 and numbered 2021/04-25)

Evaluation of the Frequency of Kidney Injury in the Postoperative Critical Care Unit (PACU): A Prospective Observational Study

Öz

Background: In the study, the frequency of postoperative acute kidney injury (AKI), factors associated with AKI, and the effect of AKI on outcomes in surgical cases treated in the Postoperative intensive care unit (PACU) in the postoperative period were investigated.
Materials and Method: The study is a prospective and observational study. Surgical cases treated in the PACU in the postoperative period were included in our study. Demographic characteristics of the patients, characteristics of the operation and anesthesia, Charlson Comorbidity Index (CCI) values, American Society of Anesthesiologist (ASA) risk classes, preoperative biochemistry results and preoperative hemogram results were recorded. Patients' AKI was assessed using the Risk, Injury, Failure, Loss of Function, and End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network criteria(AKIN).

Results: 583 postoperative cases were examined. The frequency of AKI in PACU was 17,7%. Age, preoperative CCI, BUN, GFR values, preoperative peptic ulcer history, preoperative calcium, total bilirubin levels and the urgency of operation were the preoperative reasons for AKI. Intraoperative use of blood and colloid also affected postoperative AKI. There was a relationship between AKI and the amount of crystalloid and FFP used in PACU. In patients with AKI, the frequency of inotropic use in PACU, the frequency of the use of IMV and the duration, cardiac complication, arrhythmia, respiratory system complications, sepsis and mortality rate were higher compared to patients without AKI (p <0.05).
Conclusion: In the postoperative period, the frequency of AKI was found to be 17.7% in patients treated in PACU. It was determined that there was a relationship between age, CCI, BUN, GFR, calcium, bilirubin values and the urgency of the operation and postoperative AKI. The development of AKI in the postoperative period is associated with increased morbidity and mortality.

Anahtar Kelimeler

Acute Kidney Injury, Postoperative, PACU, Critical Care

Kaynakça

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