摘要
目的通过对心外科手术后急性肾损伤(AKI)相关危险因素的分析,创建评分预警系统。方法连续性收集首都医科大学附属北京安贞医院2010年6月至2011年4月行心外科手术患者共3 500例的临床资料,进行回顾性分析。按患者是否发生AKI,分为AKI组和非AKI组。AKI组1 407例(40.2%),平均年龄(58±12)岁,男1 004例(71.4%)。非AKI组2 093例(59.8%),平均年龄(55±13)岁,男1 259例(60.2%)。根据AKI组及非AKI组的组间单因素分析和多元logistic回归分析结果创建评分预警系统,并进行验证。结果创建评分系统如下:男性为2分,年龄60岁以上每增加5岁加1分,糖尿病为2分;术前使用血管紧张素转化酶抑制剂或血管紧张素AT1受体阻断剂为1分,术前估算肾小球滤过率(eGFR)90 ml(/min.1.73 m2)以下每降低10 ml(/min.1.73 m2)加1分,术前纽约心脏学会(NYHA)心功能Ⅳ级为3分;术中体外循环时间>120 min为2分,术中低血压持续时间>60 min为2分,术后低血压持续时间>60 min为3分;术后静脉呋塞米最大量>100 mg/d为3分,术后静脉呋塞米最大量60～100 mg/d为2分,术后机械通气时间>24 h为2分。经验证该评分预警系统的受试者工作特征(ROC)曲线下面积为0.738[95%CI(0.707,0.768)],具有较好的判别能力;Hosmer-Lemeshow拟合优度检验显示其具有较好的校正能力(P=0.305)。结论我们建立了一个心外科手术后AKI评分预警系统,可能有助于临床医师实施早期预防性干预。
Abstract： Objective To analyze risk factors of acute kidney injury （AKI） after cardiac surgery in adults and develop a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively analyzed. According to whether they had postoperative AKI, all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients （40.2%） with a mean age of 58_ 12 years, including 1 004 male patients （71.4%）. The non-AKI group was consisted of 2 093 patients （59.8%） with a mean age of 55 ± 13 years, including 1 259 male patients （60.2%）. Predictive score system of postoperative AKI was established by univariate analysis between the AKI and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed： male gender （2 points）, every 5 years older than 60 years （ 1 point）, diabetes mellitus （2 points ）, preoperative use of angiotensin converting enzyme inhibitor or angiotensin AT 1 receptor blocker （ 1 point）, every 10 ml/（min＂ 1.73 m2） of preoperative estimated glomerular filtration rate （eGFR） under 90 ml/（min- 1.73m2） （ 1 point）, preoperative NYHA class 1V （3 points）, cardiopulmonary bypass time 〉 120 minutes （2 points）, intraoperative hypotension duration 〉 60 minutes （2 points）, postoperative hypotension duration 〉 60 minutes （3 points）, postoperative peak dosage of intravenous furosemide 〉 100 mg/day （3 points）, postoperative peak dosage of intravenous furosemide 60-100 mg/day （2 points）, and postoperative mechanical ventilation time 〉 24 hours （2 points）. The predictive score system presented a good discrimi- nation ability with the area under the receiver operating characteristic （ROC）curve of 0.738 with 95% CI 0.707 to 0.768, while it also presented a good calib
出处
《中国胸心血管外科临床杂志》
CAS
2013年第4期396-401,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
首都特色临床医学应用发展项目(D101100050010017)~~
