肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

主动脉内球囊反搏在老年冠状动脉移植术中的应用

目的:评价主动脉内球囊反搏在老年冠状动脉移植术中的应用。方法:回顾性分析2006年5月至2009年2月在我院行冠状动脉移植手术应用主动脉内球囊反搏(IABP)辅助的老年(≥65岁)患者资料。其中男性77例,女性34例,平均年龄(69.9±3.8)岁。结果:所有患者中非体外循环冠状动脉移植术79例,体外循环冠状动脉移植术32例。IABP术前放置32例(28.82%),术中/术后放置79例(71.17%),主要并发症有:急性肾功能损伤(45.05%),感染(35.14%)和二次气管插管(12.61%)等。术后住院死亡30例,病死率27%。术前置入IABP的患者病死率(15.63%)明显低于术中或术后置入IABP的患者病死率(31.65%,P=0.004)。患者置入IABP时间不同,其术后是否二次气管插管、是否发生急性肾功能损伤差异有统计学意义(P0.05)。多因素回归分析二次气管插管(OR=165.850,95%CI7.110～386.557,P=0.001)、感染(OR=20.911,95%CI2.940～148.710,P=0.002)和急性肾功能损伤(OR=12.557,95%CI2.935～53.716,P=0.001)是住院死亡的独立危险因素。结论:对于行冠状动脉移植术的老年患者,IABP是安全且行之有效的辅助循环手段之一,在本组研究中,术前放置IABP组患者的病死率显著低于术中/术后放置IABP组患者的病死率,故应积极预防和控制围术期并发症的发生,以降低患者的病死率。     

APACHEⅢ评分与老年冠状动脉移植术后IABP辅助治疗的医院感染

目的分析冠状动脉移植术后主动脉内球囊反搏辅助的老年患者的医院感染情况与APACHEⅢ评分的相关性。方法回顾性收集、分析我院2006年4月至2009年2月冠状动脉移植术后IABP辅助治疗的老年（≥65岁）患者的医院感染资料,并进行APACHEⅢ评分系统评估。结果 111例患者,年龄69.9±3.8岁,男77例,女34例。医院感染29例,感染率26.1%。患者平均APACHEⅢ评分为60.8±14.0,高分组患者的医院感染率和住院死亡率均高于低分组。结论医院感染是老年冠状动脉移植术后IABP辅助患者的死亡危险因素之一,APACHEⅢ评分系统可作为预测医院感染发生的方法之一。     

肾功能分级在成人心脏术后肾功能衰竭的应用

目的 探讨RIFLE分级对成人心脏术后患者临床转归的预测价值.方法 收集509例行冠状动脉移植术、瓣膜替换术成年患者资料.按照RIFLE分级、APACHE Ⅱ及SOFA评分,在心脏手术后住院期间分别对患者进行评分并记录最高分值.结果 术后呼吸机辅助时间18(14～19)h,监护室停留时间(1.4 ±1.0)d,术后住院时间12.0 d(10.0～15.0)d.根据RIFLE分级,发生不同程度急性肾功能衰竭共167例,占32.8%;住院死亡22例,死亡率4.3%,死亡率随RIFLE分级的递进有升高趋势(P<0.01).RIFLEmax的ROC曲线下面积为0.933(P<0.001).结论 ARF是心脏术后常见并发症之一,RIFLE分级对此类患者住院死亡有良好预测能力;分级进入I级和F级会明显增加住院死亡的可能.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

自体肺动脉瓣移植术围术期治疗

目的 总结自体肺动脉瓣移植术(Ross手术)围术期治疗的经验.方法 我院1994年10月-2009年2月共收治了58例中重度主动脉瓣病变行Ross手术者,其中男42例,女16例;平均年龄(28±15)岁.术前诊断:先天性心脏病,主动脉瓣中重度狭窄和(或)关闭不全54例;亚急性细菌性心内膜炎(SBE)合并主动脉瓣关闭不全1例;主动脉瓣人工机械瓣置换术后心内膜炎合并瓣周漏1例;主动脉瓣成形术后主动脉瓣大量反流1例;老年性退行性重度主动脉瓣狭窄1例.患者术前均行超声心动图(UCG)检查.术前准备:NYHA心功能分级Ⅰ、Ⅱ级患者术前按心脏手术常规准备,心功能Ⅲ级患者术前给予洋地黄、利尿剂、极化液治疗,待心功能改善后再行手术.手术方式:患者均在全麻中度低温体外循环下接受Ross手术,手术顺利.围术期监护治疗措施:严密监测生命体征,积极补充血容量,维持水、电解质和酸碱平衡,预防并有效处理心律失常的发生,维护心功能,加强抗炎治疗.结果 58例患者术后死亡1例(1.7%),自动出院1例;术后主动脉瓣平均跨瓣压差为(6.11±0.12)mm Hg,显著低于术前的(35.56±9.10)mm Hg;左室舒张末期内径(LVDD)为(56±3)mm,亦显著低于术前的(62±5)mm,差异均有统计学意义(P<0.01).左室射血分数为(0.49±0.22)%,心功能均为Ⅰ～Ⅱ级.结论 Ross手术是治疗主动脉瓣病变的有效方法,良好的围术期治疗为手术的成功提供了有力帮助.     

肾功能评分在心脏瓣膜术后急性肾损伤的应用

目的:研究旨在探讨肾脏衰竭危险、肾脏损伤、肾功能衰竭、肾功能丧失及终末期肾病(RIFLE)分级,对我院成年心脏瓣膜手术后患者临床转归的应用价值。方法:收集2006年10月至2007年3月首次行心脏瓣膜手术的成年患者资料。记录患者性别、年龄、手术类型、尿量、血生化指标和临床转归等。按照RIFLE分级在术后对患者进行评分并记录最高分值。结果:465例患者,男性182例(39.1%),女性283例(60.9%),平均年龄(50.0±11.9)岁。住院病死率2.4%。根据RIFLE分级,最终发生不同程度急性肾功能损伤(AKI)的患者共占32.0%;R级、I级和F级4组患者的住院病死率分别为:1.4%、7.7%和16.3%,以F级患者的病死率为最高(P<0.01)。受试者工作特征曲线(ROC)曲线下面积分析RIFLE和死亡之间有很好的相关性。结论:AKI是心脏瓣膜手术后的常见并发症之一,明显增加术后病死率。RIFLE分级对此类患者的预后及住院病死率有较好预测能力。     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.