ATN-ISI及APACHEⅡ评分在急性肾衰竭血透治疗中的应用

Application of ATN-ISI and APACHEⅡ score systems in prognostic assessment of hemodialysis patients with acute renal failure

目的探讨ATN-ISI和APACHEⅡ评分模型对评价血液透析(HD)治疗急性肾衰竭(ARF)预后的作用。方法行HD的ARF患者172例,采集HD前24h内最差生理参数作为ATN-ISI和APACHEⅡ模型的评分指标,以出院时患者死亡或存活为预后指标。结果全组死亡110例,病死率63.95%;≥65岁组病死率(38/46,82.61%)明显高于<65岁组(72/126,57.14%,P<0.01);全组ATN-ISI评分(0.58±0.28)分,死亡组(0.72±0.23)分,显著高于存活组(0.32±0.15,P<0.01);APACHEⅡ评分(26.41±8.81)分,死亡组(30.27±7.67)分,显著高于存活组(19.52±6.18,P<0.01)。两种评分明显正相关(r=0.81,P<0.01)。结论ATN-ISI评分简单、生理参数易采集。ATN-ISI与APACHEⅡ评分均能较好反映ARF者HD治疗的预后。

Objective To investigate the predictive value of ATN-ISI and APACHE Ⅱ score systems in prognostic assessment of hemodialysis patients with acute renal failure （ARF）. Methods Clinical data were collected from 172 patients（male 123, female 49） with average age o{（54. 5±14. 7） years old. The worst physiological criteria within 24 h before hemodialysis （HD） were taken as the indicators for scoring with ATN-ISI and APACHE Ⅱ systems. The mortality and survival rate at the time of discharge from hospital were taken for the prognostic assessment of HD. Results The hospital mortality rate was 63.95% , the patients eider than 65 years old had a higher mortality than those less than 65（82.61% vs 57.14 %, P〈0.01）. ATN-ISI scores of died group were significantly higher than those of survials [ （0. 72±0.23） vs （0. 32±0.15） scores, P〈0.01]. APACHEⅡ scores of died group were significantly higher than those of survivals[ （30.27±7.67） vs. （19.52±6.18） scores, P〈0. 01 ]. ATN-ISI scores were positively correlated to APACHE Ⅱ scores（r=0.81, P〈 0.001）. Conclusion ATN-ISI score model was simpler and easier than APACHE Ⅱ in collecting physiological data. Both scoring models are of value in predicting the mortality and renal outcome in patients with ARF.