美国克利夫兰大学急性肾功能衰竭评分系统在中国人心脏手术围术期的应用  

Application of the Clinical Score Developed by Cleveland University to Predict Acute Renal Failure after Cardiac Surgery in Chinese Patients

作　　者：章淬[1] 王翔[1] 赵谊[1] 卢剑海[1] 穆心苇[1] 

机构地区：[1]南京医科大学附属南京市第一医院ICU,南京210006

出　　处：《中国胸心血管外科临床杂志》2010年第6期467-469,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨美国克利夫兰大学医学中心急性肾功能衰竭评分系统（The Clinical Score to Predict Acute Renal Failure）预测中国人心脏手术后急性肾功能衰竭（ARF）发生的应用价值。方法将2008年8月至2009年7月期间南京医科大学附属南京第一医院收治的所有成年心脏手术患者456例纳入研究,其中男230例,女226例;年龄18-88岁,平均年龄56.7岁。术前应用克利夫兰大学的急性肾功能衰竭评分系统进行评分,按照评分结果1-5分、6-10分、≥11分将456例患者分为Ⅰ组（n=401）、Ⅱ组（n=42）、Ⅲ组（n=13）,比较3组患者急性肾损伤（AKI）发生率、在院期间进行连续性肾脏替代治疗（CRRT）发生率、多器官功能衰竭（MOSF）发生率和病死率等临床指标。结果术后Ⅰ组、Ⅱ组、Ⅲ组患者急性肾损伤的发生率分别为2.74%、28.57%和76.92%（χ2=73.004,P=0.000）,连续性肾脏替代治疗发生率分别为0.50%9、.52%和38.46%（χ2=36.939,P=0.000）,多器官功能衰竭发生率分别为0.50%、4.76%和23.08%（2χ=19.694,P=0.000）,病死率分别为0.25%、2.38%和15.38%（2χ=14.061,P=0.001）,3组间比较差异均有统计学意义。结论应用克利夫兰大学医学中心急性肾功能衰竭评分系统可以在心脏手术前有效预测中国人心脏手术后急性肾功能衰竭的发生情况,以便对高危患者采取必要的预防措施。Objective To investigate the application value of the Clinical Score developed by Cleveland University in predicting the occurrence ratio of acute renal failure in Chinese patients after cardiac surgery.Methods A total of 456 adult patients,230 males and 226 females,with cardiac surgery during August 2008 to July 2009 were included in our study.Their age ranged from 18 to 88 years with an average age of 56.7 years.Before the surgery,Clinical Score was used to predict acute renal failure after cardiac surgery.Based on the score of ≤5,6-10,or ≥11,the patients were divided into group Ⅰ（n=401）,group Ⅱ（n=42） and group Ⅲ（n=13）.The occurrence rate of acute kidney injury（AKI）,continuous renal replacement therapy in hospital,multiple organ failure,mortality and other clinical indexes were compared among the 3 groups.Results Occurrence ratio of AKI of group Ⅰ,Ⅱ,Ⅲ was respectively 2.74%,28.57% and 76.92%（χ2=73.004,P=0.000）.Continuous renal replacement therapy rate was respectively 0.50%,9.52%,and 38.46%（χ2=36.939,P=0.000）.Multiple organ failure rate was respectively 0.50%,4.76%,and 23.08%（χ2=19.694,P=0.000）.Mortality rate was respectively 0.25%,2.38%,and 15.38%（χ2=14.061,P=0.001）.There were significant differences among the three groups.Conclusion The Clinical Score to Predict Acute Renal Failure developed by Cleveland University can effectively predict the occurrence rate of acute renal failure in the Chinese patients after cardiac surgery before the operation.Therefore,corresponding preventive methods can be taken for high-risk patients.

关 键 词：心脏手术 急性肾功能衰竭 预测 

分 类 号：R692.5[医药卫生—泌尿科学] R654.1[医药卫生—外科学]