肾功能损伤分级系统在成人心脏术后的应用

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

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。Bellorno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％CI1．027—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。

Objective The aim of this study was to evaluate the ability of two acute renal faffure-specifie scoring systems （the classification by Bellomo et al and the AKIN criteria） for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1st 2006 to December 31st 2006, 509 adult patients who underwent coronary artery bypass grafting （CABG） and/ or valve opertion were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative hemadynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daffy according to the classification by Bellomo and the AKIN criteria, respectively. As references, Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ and Sepsis-related Organ Failure Assessment （SOFA）score were also calculated. Results 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. Three hundred and nine patients underwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation. Mean duratiou of ventilation support was （20.4± 17.7 ） hours, and the I CU stay was （ 1.4 ± 1.0 ） days. Postoperative hospital stay was （ 13.8± 9.1 ） days. According to the classification by BeUomo., the highest in-hospital mortality was 52.9% in ARFS group. Multiplication of in-hospital mortality rate was observed （χ^2 for trend, P 〈 0.01） in 0.4% （non-ARF）, 1.2% （stage 1）, 12.0% （stage 2） and 32.4% （stage 3） of patients based on the AKIN criteria. By applying the area under the receiver operating characteristic curve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthermore, 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. Conclusion Analytical data confimed good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.