肾功能损伤分级系统在成人心脏术后的应用

目的 探讨肾功能损伤分级系统在成人心脏术后的临床应用价值.方法 连续收集2006年10月1日至2006年12月31 日(以手术日期为准)首次行冠状动脉移植术和(或)瓣膜置换术的509例病人资料.记录性别、年龄、手术类型、围术期血流动力学指标、尿量、血生化指标和临床转归等内容.按照Bellomo评分和AKIN分级系统在心脏手术后分别对病人进行分级、评分.结果 509例中男341例(67.0%),女168例(33.0%),平均年龄(56.2±12.0)岁.行冠状动脉移植术309例,瓣膜手术182例,冠状动脉移植术合并瓣膜手术18例.Bellomo评分和AKIN分级ROC曲线下面积分别为0.875和0.923.多因素Logistic回归分析显示,AKIN分级OR值为5.478(P=0.028,95%CI 1.027～24.856).结论 ARF是心脏手术后的常见并发症之一,BellOMO评分和AKIN分级系统对心脏手术后ARF病人的住院死亡有良好的预测能力.

Acute renal failure after cardiac surgery in intuit in adult patients : evaluation of the ARF-specific scoring systems

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.