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.

Postoperative acute renal failure in adult patients with cardiac surgery: evaluation of the RIFLE classification

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.