小儿法洛四联症根治术后急性肾损伤诊断标准的评价:pRIFLE标准和KDIGO标准  

Evaluation of diagnostic criteria for acute kidney injury after radical operation for tetralogy of Fallot in children:pRIFLE criterion and KDIGO criterion

作　　者：贾爰[1] 罗启鹏 李轶楠 康文英[1] 袁素[1] 晏馥霞[1] Jia Yuan;Luo Qipeng;Li Yinan;Kang Wenying;Yuan Su;Yan Fuxia(Center of Anesthesiology,National Center for Cardiovascular Diseases Fuwai Hospital Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]北京协和医学院国家心血管病中心心血管疾病国家重点实验室中国医学科学院阜外医院麻醉中心,100037

出　　处：《中华麻醉学杂志》2020年第5期533-537,共5页Chinese Journal of Anesthesiology

摘　　要：目的从术后转归角度,评价pRIFLE标准、KDIGO标准用于诊断小儿法洛四联症术后急性肾损伤(AKI)的准确性。方法连续回顾性选择8岁以内行法洛四联症根治术患儿375例,分别依据pRIFLE和KDIGO标准,诊断患儿术后AKI发生情况及其分级,对预后指标(术后机械通气时间、ICU停留时间、术后住院时间、住院总费用及住院死亡率等),比较不同AKI分级之间的差异。采用logistic回归法,分析两种不同标准诊断AKI时,导致术后住院时间延长(≥14 d)的危险因素。对采用KDIGO标准诊断为非AKI的患儿,进一步采用pRIFLE标准确认,并对诊断为AKI和非AKI患儿的预后指标进行比较。结果两种标准诊断法洛四联症根治术后AKI时,其发生率分别为56.8%(pRIFLE标准)和40.0%(KDIGO标准)。根据两种标准诊断的AKI均是术后住院时间延长的独立危险因素,且与非AKI(AKI 0级)患儿相比,AKI患儿预后各指标(术后机械通气时间、ICU停留时间、术后住院时间、住院总费用及住院死亡率)的水平均升高(P<0.01)。KDIGO标准诊断为非AKI的225例患儿中,根据pRIFLE标准诊断AKI 63例和非AKI 162例,而AKI和非AKI患儿的术后转归各指标比较,差异均无统计学意义(P>0.05)。结论从术后转归角度评价小儿法洛四联症根治术后AKI的诊断,pRIFLE标准的灵敏度偏高,而KDIGO标准的准确性更优。Objective To evaluate the accuracy of pRIFLE criterion and KDIGO criterion for the diagnosis of acute kidney injury(AKI)after radical operations for tetralogy of Fallot in children from the perspective of postoperative outcomes.Methods A total of 375 children,aged<8 yr,undergoing radical operations for tetralogy of Fallot,were selected continuously and retrospectively.According to the pRIFLE and KDIGO diagnostic criteria,postoperative AKI was diagnosed,and the children were classified into different AKI grades.The prognostic parameters(postoperative mechanical ventilation time,duration of intensive care unit(ICU)stay,postoperative length of hospital stay,total costs of hospitalization,and in-hospital mortality,etc.)were collected,and the differences among different AKI grades were compared.Logistic regression method was used to analyze the risk factors for prolonged postoperative length of hospital stay(≥14 days)when two different criteria were used to diagnose AKI.The children diagnosed as non-AKI by KDIGO criterion were further confirmed using pRIFLE criterion,and the prognostic parameters in the children who were diagnosed as AKI and non-AKI were compared.Results When two different criteria were used to diagnose AKI after radical resection for tetralogy of Fallot,the incidence was 56.8%(pRIFLE criterion)and 40.0%(KDIGO criterion).AKI diagnosed according to the two criteria was the independent risk factor for prolonged postoperative length of hospital stay,and the levels of all the prognostic parameters(postoperative mechanical ventilation time,duration of ICU stay,postoperative length of hospital stay,total costs of hospitalization,and in-hospital mortality)were significantly higher in AKI children than in non-AKI(AKI grade 0)children(P<0.01).Among the 225 children diagnosed as non-AKI according to the KDIGO criterion,63 cases were diagnosed as AKI and 162 cases as non-AKI according to the pRIFLE criterion,however,there was no significant difference in each prognostic parameter between children with AKI and

关 键 词：急性肾损伤 诊断 参考标准 心脏外科手术 手术后并发症 儿童 法乐四联症 

分 类 号：R726.5[医药卫生—儿科]