急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值  

Application of Acute Kidney Injury Criteria and Classification to Predict Mortality Following Cardiovascular Surgery

作　　者：王旭冬[1] 车妙琳[2] 谢波[1] 连锋[1] 刘沙[1] 胡振雷[1] 薛松[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心胸外科,上海200025 [2]上海交通大学医学院附属仁济医院肾脏科,上海200025

出　　处：《中国胸心血管外科临床杂志》2012年第6期619-623,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的了解心脏手术后急性肾损伤(AKI)的发病及预后情况,探讨急性肾损伤网络(AKIN)会议推荐的AKI分期预测患者院内死亡的应用价值。方法将2004年1月至2007年6月上海交通大学医学院附属仁济医院收治的所有成年心脏手术患者1 056例纳入研究,采用AKIN推荐的AKI定义及分期标准评估心脏手术后AKI的发病率及住院病死率,并采用单因素和logistic多因素回归分析法对术前、术中、术后与AKI发生可能相关的危险因素进行分析。结果在1 056例行心脏手术的患者中,328例发生AKI,发生率为31.06%;AKI患者的住院病死率显著高于非AKI患者(11.59%vs.0.69%,P<0.05)。Logistic多因素回归分析显示:年龄每增加10岁(OR=1.40)、术前高尿酸血症(OR=1.97)、术前左心功能不全(OR=2.53)、冠状动脉旁路移植术(CABG)加心瓣膜手术(OR=2.79)、手术时间每增加1 h(OR=1.43)和术后循环血容量不足(OR=11.08)是心脏手术后发生AKI的独立危险因素。AKIN分期预测患者院内死亡的ROC曲线下面积为0.865,95%可信区间为0.801-0.929。结论随着AKIN分期的上升,心脏手术患者住院病死率逐步升高。年龄高、术前高尿酸血症、术前左心功能不全、CABG加心瓣膜手术、手术时间延长和术后循环血容量不足是心脏手术后并发AKI的独立危险因素。AKIN分期可以有效预测心脏手术患者发生院内死亡的风险,为及早对高危人群采取有效的预防干预措施提供依据。Objective To evaluate the incidence and prognosis of postoperative acute kidney injury（AKI） in patients after cardiovascular surgery,and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network（AKIN） definition to predict their in-hospital mortality.Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine,Shanghai Jiaotong University from Jan.2004 to Jun.2007 were included in this study.AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients.Univariate and multivariate analyses were used to evaluate preoperative,intraoperative, and postoperative risk factors related to AKI.Results Among the 1 056 patients,328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients（11.59% vs.0.69%,P0.05）.Multivariate logistic regression analysis suggested that advanced age（OR=1.40 per decade）,preoperative hyperuricemia（OR=1.97）,preoperative left ventricular failure（OR=2.53）,combined CABG and valvular surgery（OR=2.79）,prolonged operation time（OR=1.43 per hour）,postoperative hypovolemia（OR=11.08） were independent risk factors of AKI after cardiovascular surgery.The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865（95% CI 0.801-0.929）.Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery.Advanced age,preoperative hyperuricemia,preoperative left ventricular failure,combined CABG and valvular surgery,prolonged operation time,postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery.AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery,which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.

关 键 词：心脏手术 急性肾损伤 病死率 预测 

分 类 号：R654.2[医药卫生—外科学]