血管活性药物评分与心血管外科术后急性肾损伤的相关性研究  

Correlation between vasoactive-inotropic score and postoperative acute kidney injury after cardiovascular surgery

作　　者：侯克龙 沈骁 李静[2] 邹磊[2] 章淬[2] 穆心苇[2] Hou Kelong;Shen Xiao;Li Jing;Zou Lei;Zhang Cui;Mu Xinwei(Department of Critical Care Medicine,the Third People’s Hospital of Bengbu,Bengbu 233000,China;Department of Critical Care Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]蚌埠市第三人民医院重症医学科,233000 [2]南京医科大学附属南京医院(南京市第一医院)重症医学科,210006

出　　处：《中国心血管杂志》2021年第5期457-462,共6页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨血管活性药物评分(VIS)与心血管外科术后患者发生急性肾损伤(CVS-AKI)的相关性。方法本研究为单中心回顾性观察性研究。筛选2017年9月至2019年5月南京医科大学附属南京医院重症医学科收治的2112例成年心血管外科术后患者。收集患者术后24 h内血管活性药物使用情况,并根据公式计算VIS最高值(VIS-max),分析VIS-max与CVS-AKI之间的相关性。结果最终纳入心血管外科手术后患者2041例,包括非CVS-AKI组1644例和CVS-AKI组397例,其中41例(2.0%,41/2041)患者需行连续性肾脏替代治疗(CRRT)。在397例CVS-AKI患者中,分别有4例(0.2%,4/2041)AKI-1期、17例(0.8%,17/2041)AKI-2期和20例(1.0%,20/2041)AKI-3期患者需行CRRT。CVS-AKI组的术后24 h内VIS-max高于非CVS-AKI组[10(7,15)分比5(3,7)分,Z=-21.863,P<0.001]。多因素logistic回归分析显示,术前血肌酐、中性粒细胞明胶酶相关脂蛋白、血红蛋白和血尿酸水平,术中红细胞输注量,术后24 h内血乳酸水平和VIS-max(OR=1.30,95%CI:1.24~1.37,P<0.001)与CVS-AKI显著相关。VIS-max的受试者工作特征曲线下面积为0.847(95%CI:0.827~0.868,P<0.001),取截断值为6.5分,敏感度83.4%,特异度72.8%。结论术后24 h内VIS-max可在一定程度上预测CVS-AKI的发生。Objective To investigate the correlation between vasoactive-inotropic score(VIS)and acute kidney injury(CVS-AKI)in patients after cardiovascular surgery.Methods This study was a single-center retrospective observational study.The 2112 adult patients underwent cardiovascular surgery in Department of Critical Care Medicine in Nanjing First Hospital from September 2017 to May 2019 were enrolled.The maximum value of VIS(VIS-max)was calculated by using the highest doses of vasoactive and inotropic medications within the first 24 h after cardiovascular surgery.The correlation between VIS-max and CVS-AKI was evaluated.Results A total of 2041 adult patients with cardiovascular surgery were finally enrolled.Among them,397 patients(19.5%)developed postoperative AKI,and 41 patients(2.0%,41/2041)required continuous renal replacement therapy(CRRT).In 397 patients with CVS-AKI,4 patients(0.2%,4/2041)with AKI class 1,17 patients(0.8,17/2041)with AKI class 2,and 20 patients(1.0%,20/2041)with AKI class 3 required CRRT,respectively.The level of VIS-max in CVS-AKI group was significantly higher than that in the non-AKI group(10[7,15]points vs.5[3,7]points,Z=-21.863,P<0.001).Multivariate logistic regression analysis showed 7 independent risk factors for postoperative AKI:preoperative serum creatinine,hemoglobin,serum uric acid,neutrophil gelatinase-associated lipocalin,intraoperative RBC units,postoperative lactate and VIS-max(OR=1.30,95%CI:1.24-1.37,P<0.001).The area under the receiver operating characteristic of VIS-max was 0.847(95%CI:0.827-0.868,P<0.001),the cutoff value was 6.5 points,with sensitivity of 83.4%and specificity of 72.8%.Conclusions VIS-max within 24 h after surgery might be a good predictor for occurrence of CVS-AKI in adult patients after cardiovascular surgery.

关 键 词：血管活性药物评分 心血管外科手术 急性肾功能不全 

分 类 号：R654[医药卫生—外科学] R692[医药卫生—临床医学]