医学课堂︱73岁的老太太做完直肠癌手术后，因为这个原因导致了肾衰竭……( 四 ) _健康小知识

对于ACEI及ARB类药物，有学者推荐在术前至少24h停药，以减少术中低血压及术后AKI的发生[1] 。但一项纳入了949例胃肠道及肝胆手术的研究则发现，停用ACEI类及ARB类药物与否，两组间AKI的发生并无明显差异[21] 。 NSAIDs类药物对术后AKI的影响尚不明确[22] 。
我们团队处置的这位患者，考虑是造口高流量+外源性补充较少+药物（ARB类降压药）等多因素作用引起的AKI 。治疗上，我们在积极扩容的同时给患者进行血透，患者肾功能得到快速的改善。从文献复习的结果看，我们或许可以观察扩容的治疗效果后再决定是否进行血透。
减少回肠造口术后AKI最好的方法：预防重于治疗。首先，术者要对回肠造口可能诱发AKI提起足够重视，这样才能对患者进行良好的术前宣教及术后指导。告知患者如何观察造口引流量、尿量、有无脱水等，并对患者进行正确的饮食指导。而我们就是因为对这个问题不够重视，或许导致了这例AKI的发生。有学者[18]建议在患者出院前2天停掉所有补液，鼓励患者经口进食，并保证每日尿量在1200ml以上。出院后两周内，患者要每日监测尿量及造口引流量，而尿量的监测更为重要。每日造口引流量应少于1200-1500ml ，而尿量要超过1200ml 。另外，建议患者每日进食至少2400ml液体[9] 。
一句话总结：回肠造口术后AKI的发生，需要引起医患双方足够重视。术前宣教、出院后指导及必要的药物治疗手段有助于减少AKI、再入院等问题的发生。
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