RIFLE标准在心脏术后急性肾损伤病人中的评价

目的 探讨RIFLE标准在心脏术后急性肾损伤(AKI)病人肾替代治疗时机选择中的作用及与预后的关系.方法 回顾分析145例心脏术后AKI病例,分为连续性静脉一静脉血液滤过(CVVH)组(98例)和非CVVH组(47例).应用RIFLE标准对AKI进行分期,对比分析各组病人的临床资料、疗效和预后.结果 AKI Ⅰ期和Ⅲ期中CVVH组与非CVVH组的医院病死率差异无统计学意义;Ⅱ期中非CVVH组的医院病死率高于CVVH组(58.8%对26.1%,P<0.0).CVVH组生存者中,CVVH治疗、尿量恢复、机械通气、ICU滞留和术后医院滞留时间随AKI分期的加重而延长.结论 RIFLE标准对心脏术后AKI早期诊断和判断预后有指导意义.必须强调肾脏替代时机的选择,在AKI Ⅱ期即行肾替代治疗可以明显改善预后,而CVVH比间断血液透析和腹膜透析更有优势.

An assessment of the RIFLE criteria for acute kidney injury in patients after cardiac surgery

Objective To investigate the effect of RIFLE criteria for acute kidney injury (AKI) patients after cardiac surgery and the connection between prognosis and timing of continuous veno-venous hemofiltration (CVVH). Methods A retrospective study was carried out in 145 patients with AKI after cardiac surgery. The patients were divided into two groups: CVVH group (98 cases) and non-CVVH group (47 cases). RIFLE criteria were used for AKI phases. Clinical data, treatment and prognosis of patients were analyzed by statistical methods. Results In patients with AKI phase Ⅰ and Ⅲ, there was no significant difference in the mortality rate of CVVH group and of non-CVVH group. In phase Ⅱ, the mortality rate of non-CVVH group (58.8%) was higher than CVVH group (26.1% ) ( P<0.05). Mean duration of CVVH, urine recovery time (time from CVVH to urine volume>1 ml·kg-1·h-1), duration of mechanical ventilation, ICU stay and postoperative hospital stay of survival in CVVH group increased with increase of AKI phases.Conclusion The AKI grading based on RIFLE criteria will help in early diagnosis and assessment of prognosis of AKI after cardiac surgery. It is important to choose the appropriate timing of replacement therapy. Early renal replacement therapy can improve the prognosis for patients in AKI phase Ⅱ, and CVVH have more advantages than IHD and PD.