Analysis Of Risk Factors And TCM Syndrome Elements Of Acute Kidney Injury After Surgery In A TCM Hospital

Objective:To analyze the risk factors and distribution characteristics of TCM syndrome elements in patients with AKI after surgery,so as to provide basis for early prevention and treatment.Method:This study used retrospective research methods to collect the general basic information,operation related data and TCM syndrome distribution data of patients with AKI after surgery in the inpatients of peripheral vascular department,orthopedics and general surgery from January 2016 to January 2021 of Dongzhimen Hospital of Beijing University of traditional Chinese medicine.Aki was diagnosed by the 2012 global organization for the improvement of prognosis(kidney D isease:Improving Global The diagnostic criteria of TCM syndrome refer to the "national standard of the people’s Republic of China for TCM clinical terms and syndromes" issued in 1997.The risk factors of AKI after surgery were analyzed,and the distribution characteristics of TCM syndrome factors of AKI were discussed.Results:(1)Basic situation comparison:A total of 416 postoperative patients were included in this study.131 patients developed AKI after surgery and 285 patients did not develop AKI after surgery.There were 100 cases of AKI in peripheral vascular department,20 cases in orthopedics department and 11 cases in general surgery department.After surgery,1 10 cases(84%)had AKI stage 1,15 cases(11%)had AKI stage 2 and 6 cases(5%)had AKI stage 3.There were 40 cases(31%)of pre renal factors,70 cases(53%)of renal factors and 21 cases(16%)of post renal factors.The average age of AKI patients after surgery was 66±5 years old,BMI is 23.7±9 kg/m2,the average length of stay was 36±On the 5th day,the average age,BMI and average length of stay of AKI patients after surgery were higher than those of non AKI patients(P<0.05).Among 131 patients with postoperative AKI,113(86.3%)were complicated with hypertension,120(91.6%)with diabetes mellitus,83(63.4%)with coronary heart disease,70(53.4%)with smoking history,76(58%)with cerebrovascular disease,104(79.4%)with hyperlipidemia and 98(74.8%)with basic renal insufficiency,There were significant differences in hypertension,diabetes,smoking history,hyperlipidemia and basic renal insufficiency between the two groups(P<0.05).Among 131 patients with postoperative AKI,40(30.5%)used diuretics,73(55.7%)used ACEI/ARB,91(69.5%)used antibiotics,50(38.2%)used contrast agents and 75(57.3%)used NSAIDs.The utilization rates of the above five drugs in AKI patients after surgery were higher than those in non AKI patients after surgery,and the differences in the use of antibiotics and contrast agents between the two groups were statistically significant(P<0.05).(2)Laboratory examination index:preoperative serum creatinine value of AKI patients after surgery was 89.8±6umol/L,preoperative hemoglobin 99.7±3g/L,preoperative serum uric acid 418.8±81.2umol/L。The preoperative serum creatinine and uric acid levels of AKI patients after surgery were higher than those of non AKI patients,and the preoperative hemoglobin value was lower than that of non AKI patients.There were significant differences in the preoperative serum creatinine,uric acid and hemoglobin values between the two groups(P<0.05).(3)Intraoperative data:the operation time(min)of AKI group was 90[60120],and the intraoperative blood loss was 164±After surgery,the operation time and blood loss of AKI group were greater than those of non AKI group.There were significant differences in operation time and blood loss between the two groups(P<0.05).After surgery,AKI patients were mainly treated with grade 4 surgery,and there was significant difference in surgical grading between the two groups(P<0.05).(4)Postoperative outcome:the in-hospital mortality rate of surgical AKI group(5.3%)was significantly higher than that of non AKI group(1.7%),the difference was statistically significant(P<0.05);The ICU transfer rate of AKI group(7.6%)was significantly higher than that of non AKI group(2.1%),and the difference was statistically significant(P<0.05);The postoperative ICU days and postoperative hospital stay of AKI group were longer than those of non AKI group,and the difference was statistically significant(P<0.05).(5)The distribution of TCM syndrome elements in patients with AKI after surgery:deficiency and excess syndrome was the most common;Qi deficiency and blood deficiency are the main syndrome elements of deficiency syndrome;Blood stasis,heat toxin and dampness heat are the main syndrome elements of syndrome type.The proportion of qi deficiency,blood stasis,heat toxin and damp heat in TCM syndrome elements of postoperative AKI patients was higher than that of postoperative non AKI patients,and the difference was statistically significant(P<0.05).(6)The distribution of TCM syndrome elements of patients with AKI after surgery of different etiologies:the TCM syndrome elements of patients with AKI after surgery caused by prerenal factors were mainly mixed with deficiency and excess,and the syndrome elements were mainly found in blood deficiency,Qi deficiency,blood stasis and heat toxin;The TCM syndrome elements of AKI patients caused by renal factors are mainly blood stasis,damp heat,heat toxin and blood deficiency;The main TCM Syndromes of AKI after surgery caused by postrenal factors are excess syndrome and deficiency excess syndrome.The main syndrome elements are heat toxin,damp heat,blood stasis and blood deficiency.The frequency of qi deficiency and blood deficiency in prerenal venereal diseases was higher than that in renal venereal diseases and postrenal venereal diseases,and the difference was statistically significant(P<0.05).The frequency of damp heat in postrenal etiology was higher than that in prerenal etiology and renal etiology,and the difference was statistically significant(P<0.05).Conclusion1.Age,hypertension,diabetes,smoking history,preoperative serum uric acid,basic renal insufficiency,antibiotics,contrast media,BMI,operation time and intraoperative blood loss were independent risk factors for AKI after surgery.2.In AKI group,the syndrome of deficiency and excess was more common;Qi deficiency and blood deficiency are the main syndrome elements of deficiency syndrome;Blood stasis,heat toxin and dampness heat are the main syndrome elements of syndrome type.