老年人心血管手术后急性肾功能损伤预后评价的临床观察

Evaluation of acute kidney injury network criteria in post-cardiosurgery elderly patients with acute kidney injury

目的探讨急性肾功能损伤（acutekidneyinjury，AKI）分级系统对老年心脏手术后患者预后的预测价值。方法收集2006年10月至2007年1月首次行冠状动脉移植术和（或）心脏瓣膜植换术的老年患者资料，记录患者性别、年龄、手术类型、尿量、血生化指标和临床转归等，按照AKI网络工作组（acutekidneyinjurynetwork，AKIN）分级及急性生理学和慢性健康状况评价系统（APACHEⅡ）评分在术后对患者进行评分并记录最高分值。结果225例患者中男169例（75．1％），女56例（24．9％），平均年龄（66．7±5．0）岁。住院病死率5．8％（13例）。根据AKIN分级，最终发生不同程度AKI的患者占55．6％（125例）；AKIN分级1级（96例）、2级（11例）、3级（18例）患者的住院病死率分别为2．1％（2例）、9．1％（1例）和50．0％（9例），病死率随AKIN分级的递增有升高趋势（P〈0．01）。受试者工作特征曲线下面积分析AKIN和病死率具有相关性；Logistic回归分析结果显示，随AKIN分级的递增，相对死亡危险性增加。结论AKI是老年人心脏手术后的常见并发症之一，可增加术后病死率。AKIN分级系统对此类患者的预后及住院死亡有良好预测价值。

Objective To evaluate tile value of acute kidney injury network （AKIN） criteria for predicting hospital mortality in post cardiosurgery elderly patients. Methods From October 2006 to January 2007, the elderly patients who underwent coronary artery bypass grafting or valve replacement operation were enrolled in this study. The medical data included gender, age, operation type, perioperative hemodynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed according to the AKIN criteria, and severity of illness was determined after surgery by calculating Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ ） score. Results A total of 225 patients underwent cardiac surgery during this period, 169 patients were male （75.1G）, while 56 were female （24.9%）, mean age was （66.7 ±745.0） years old. The overall hospital mortality rate was 5.8% （13/225）. According to AKIN criteria, there were 125 patients with acute kidney injury （55.6%）, and the hospital mortality of stage 1, 2 and 3 patients were 2. 1% （2/96）, 9.1% （1/11） and 50.0% （9/18） respectively. A significant increase was observed in mortality based on AKIN criteria （P〈0. 01）. By applying the area under the receiver operating characteristic curve, the AKIN criteria had a good discriminative power. Conclusions Both the incidence and mortality rate of acute kidney injury in the post-cardiosurgery elderly patients are high, the AKIN criteria is a simple and valuable method with a good prognostic capability for evaluating acute kidney injury.