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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。
Objective To establish a scoring early warning system by analyzing the risk factors associated with acute renal injury (AKI) after cardiac surgery. Methods The clinical data of 3 500 patients undergoing cardiac surgery from June 2010 to April 2011 at Beijing Anzhen Hospital Affiliated to Capital Medical University were collected continuously for retrospective analysis. According to whether patients with AKI, divided into AKI group and non-AKI group. There were 1,407 (40.2%) patients in the AKI group, with an average age of (58 ± 12) years and 1,004 male patients (71.4%). There were 2 093 (59.8%) non-AKI patients with a mean age of 55 ± 13 years and 1 259 male patients (60.2%). According to the results of univariate analysis and multivariate logistic regression analysis between groups according to AKI group and non-AKI group, a score early warning system was created and verified. Results The scoring system was as follows: 2 points for men, 1 point for each additional age of 60 years or older, and 2 points for diabetes. Angiotensin converting enzyme inhibitors or angiotensin AT1 receptor blockers were preoperatively administered as 1 Points, preoperative assessment of glomerular filtration rate (eGFR) 90 ml (/min.1.73 m2) for each reduction of 10 ml (/min.1.73 m2) plus 1 minute before the New York Heart Association (NYHA) cardiac function Ⅳ Grade 3 points; intraoperative and extracorporeal circulation time> 120 min to 2 points, duration of intraoperative hypotension> 60 min to 2 points, duration of postoperative hypotension> 60 min to 3 points; postoperative venous furosemide most A large number of> 100 mg / d for 3 minutes, the maximum amount of intravenous furosemide 60 ~ 100 mg / d to 2 points, mechanical ventilation> 24 h after 2 minutes. The area under the receiver operating characteristic (ROC) curve of the scoring system was 0.738 [95% CI (0.707,0.768)], which showed good discriminative power. The Hosmer-Lemeshow goodness-of-fit test showed that the score Good correction ability (P = 0.305). Conclusions We have established an early warning system for AKI scores after cardiac surgery that may help clinicians implement early preventative interventions.