三种评分在心脏术后接受连续性肾脏替代治疗患者预后评价中的应用

Application of three scoring systems in evaluation of prognosis of patients undergoing continuous renal replacement therapy after cardiac surgery

目的探讨多器官功能障碍评分(MODS)、简化急性生理评分Ⅱ(SAPSⅡ)和血管活性肌力药物评分(VIS)对心脏术后行连续性肾脏替代治疗(CRRT)患者预后评价的预测作用。方法调查2010年11月—2014年6月在上海市胸科医院外科监护室行CRRT的心脏术后成年患者,根据出院时治疗结果分为存活组和死亡组。分别对所有患者在手术后第1日和CRRT前1日进行病情严重程度评分,并以受试者工作特征曲线下面积(AUCROC)大小衡量各评分系统对患者预后的预测能力。结果 32例心脏术后急性肾损伤(AKI)接受CRRT的患者被纳入该研究,其中9例存活,23例死亡,死亡率为71.9%。死亡组患者无论是在术后第1日还是在CRRT前1日的MODS、SAPSⅡ和VIS的3种评分均显著高于存活组,差异均有统计学意义(P<0.05或P<0.01)。术后第1日VIS、CRRT前1日MODS、CRRT前1日SAPSⅡ和CRRT前1日VIS的4个评分,AUCROC分别为0.821、0.816、0.800和0.768,两两之间比较差异无统计学意义(P>0.05)。高VIS组在术后90 d存活率明显低于低VIS组,且术后低心排量综合征和再次剖胸探查发生率更高。结论术后第1日VIS、CRRT前1日MODS、CRRT前1日SAPSⅡ和CRRT前1日VIS都能较好地预测心脏术后行CRRT治疗患者的预后,术后第1日VIS作为早期指标更优。高VIS与不良预后相关。

Objective To evaluate the prediction of prognosis of patients undergoing the continuous renal replacement therapy（ CRRT） after cardiac surgery by the multiple organ dysfunction score（ M O DS）, simplified acute physiology score Ⅱ（ SAPS Ⅱ）, and vasoactive-inotropic score（ V IS）.Methods Data of patients undergoing CRRTafter the cardiac surgery fromN ovember, 2010 to June, 2014 in the Surgical Intensive Care U nit of Shanghai Chest H ospital were collected.Patients were divided into the survival group and death group according to the result of treatment.The severity of disease of all patients was evaluated one day after surgery and one day before CRRT.The prediction of prognosis of patients by 3 scoring systems was evaluated by the area under the receiver operator characteristic curve（ AU CRO C）.Results A total of 32 adult patients with acute kidney injury（ AKI） who underwent CRRTafter the cardiac surgery were enrolled.Among them, 9patients survived and 23 patients died.The mortality rate was 71.9%.The scores of M O DS, SAPSⅡ, and V IS of the death group one day after surgery and one day before CRRTwere significantly higher than those of the survival group.The differences were statistically significant（ P〈0.05 or P〈0.01）.AU CRO Cof V IS one day after surgery and M O DS, SAPS Ⅱ, and V IS one day before CRRTwere 0.821, 0.816, 0.800, and 0.768 respectively.The differences of any two of themwere not statistically significant（ P〉0.05）.The survival rate of the group with high V IS 90 d after surgery was significantly lower than that of the group with lowV IS.The incidences of lowcardiac output syndrome（ LCO S） and exploratory thoracotomy of the group with high V IS were higher than those of the group with lowV IS.Conclusion V IS one day after surgery and M O DS, SAPSⅡ, and VIS one day before CRRTcan ideally predict the prognosis of patients undergoing CRRTafter cardiac surgery.V IS one day after surgery is the best early index.H igh V IS is correlated with the poor prognosis.