肾功能损伤分级在婴幼儿心脏术后的应用

Assessment of AKIN criteria for postcardiotomy children patients

目的探讨肾功能损伤（AKIN）分级系统预测婴幼儿心脏术后病死率价值。方法选择2009年1月1日至2010年12月31日在安徽省立儿童医院心脏外科进行先心病手术的580例婴幼儿作为研究对象,收集其年龄、性别、围术期血流动力学参数、尿量、血生化和临床转归等资料,采用AKIN分级系统对患儿心脏术后的肾功能进行评分、分级。结果 580例先心病手术患儿的平均年龄为（3.7±3.1）岁,男女比例为318/262,术后急性肾功能损伤的罹患率为29.31%,不同级别肾功能损伤的病死率分别为：Non-ARF 0.98%（4/410）、l级2.3%（3/132）、2级17.6%（3/17）和3级28.6%（6/21）。AKIN分级ROC曲线下面积为0.905。多因素Logistic回归分析显示,肾功能损伤程度与患儿术后病死率间存在显著的关联性（OR：95%CI为3.67∶2.35~5.72,趋势性检验P〈0.001）。结论 AKIN分级系统可以用以预测心脏手术后ARF患儿的住院死亡风险。

Objective To assess the ability of acute kidney injury network（AKIN） criteria for predicting hospital mortality of the postcardiotomy children patients.Methods From Jan 1st,2008 to Dec 31st,2010,580 children patients received cardiotomy were enrolled in this study.The information of these patients such as age,gender,perioperative hemodynamic parameters,urine output,biochemical parameters and outcome,et al was collected by the well trained nurses.Renal function was assessed daily according to the classification by the AKIN criteria respectively.Results For the 580 patients,318 were boys（54.83%） and 262 were girls（45.17%）,the mean age was 3.7±3.1 years old.The prevalence of the postoperative acute renal failure（ARF） was 29.31%.The mortality of Non-ARF and different stages of ARF was： 0.98%（4/410） for Non-ARF,2.3%（3/132） for stage 1,17.6%（3/17） for stage 2,and 28.6%（6/21） for stage 3,respectively.Undercurve area of receiver operating characteristic（ROC） curve was 0.905.Multiple Logistic regression model was conducted to adjust the potential confounding risk factors,such as age,gender,perioperative hemodynamic parameters,biochemical parameters,etc.There was a significant association between the mortality and AKIN（OR： 95%CI was 3.67： 2.35-5.72,P value of the trend test was less than 0.001）.Conclusion AKIN criteria can be used to predict the death risk for children received the cardiac surgery.