手术后连续性肾脏替代治疗患者急性生理学与慢性健康状况评分效果及高危因素分析

›› 2011, Vol. 10 ›› Issue (6): 298-301.

手术后连续性肾脏替代治疗患者急性生理学与慢性健康状况评分效果及高危因素分析

徐静沈平雁马晓波陈晓农张文

上海交通大学医学院附属瑞金医院肾内科

收稿日期:2011-04-13 修回日期:1900-01-01 出版日期:2011-06-12 发布日期:2011-06-12
通讯作者: 张文

The risk factors and the acute physiology and chronic health evaluation (APACHE) scores in post-operation patients treated with continuous renal replacement therapy

XU Jing, SHEN Ping-yan, MA Xiao-bo, CHEN Xiao-nong, ZHANG Wen

Received:2011-04-13 Revised:1900-01-01 Online:2011-06-12 Published:2011-06-12

摘要/Abstract

摘要：

目的分析针对手术后患者行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的预后相关危险因素，探讨急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)在手术后CRRT重症患者中的评估效果。方法以上海交通大学附属瑞金医院2004年至2007年手术后行CRRT患者为研究对象，于CRRT前24 h以内计算APACHE Ⅱ、Ⅲ。APACHE根据急性生理学指标、年龄和慢性健康状况3项评分。采用SPSS 15.0版本医学统计软件，计量资料均以均数±标准差表示，率的比较用卡方检验，组间比较用单样本t检验，以P＜0.05为差异有统计学意义。高危因素分析采用logistic多因素回归分析。结果共收集有详细资料的手术后行CRRT患者86例，平均年龄为 (62.2±16.2)岁，男性57例，女性29例；重症监护病房(intensive care unit,ICU)患者54例，非ICU患者32 例；手术类型包括心脏手术32例(瓣膜手术13例和冠状动脉脉手术19例，均为手术相关性AKI高危术式)，普外科手术23例，移植手术18例(肝移植16例和肾移植2例)，胸外科手术6例(包括食道手术和肺切除术)，创伤手术7例(神经外科手术5例和其他手术2例)。存活29例，死亡57例，死亡率为66.3%。APACHE Ⅱ均值为(26.3±7.2)分：死亡组(27.9±7.3)分，存活组(23.0±5.8)分，2组之间差异有统计学意义(P＜0.01)。APACHE Ⅲ均值为(67.4±18.0)分：死亡组(71.2±18.4)分，存活组(60.0±14.8)分，2组间差异有统计学意义(P＜0.01)。APACHE Ⅲ较APACHE Ⅱ在预测手术后CRRT患者的死亡风险上并无明显优势，2者差异无统计学意义(P＞0.05)。多因素回归分析得出，影响手术后CRRT患者死亡的高危因素为机械通气(P＜0.01)和多器官功能障碍综合征(P=0.033)。结论 APACHE与疾病严重程度密切相关，与手术后行CRRT患者的转归更是高度关联，评分越高，死亡风险越大，对其进行APACHE可早期预测死亡风险，但无需同时使用2种评分。手术后行CRRT患者若使用机械通气或伴有多器官功能障碍综合征，其死亡危险更高。

关键词: 手术后期间, 危险因素, 连续性肾脏替代治疗, 急性生理学与慢性健康状况评分

Abstract:

Objective To investigate the risk factors relating to prognosis and to evaluate the clinical situation using APACHE scores in critical patients after surgery and treated with continuous renal replacement therapy (CRRT). Subjects and methods Patients after surgery and treated with CRRT were recruited from several departments in Shanghai Ruijin Hospital affiliated to Shanghai JiaoTong University, School of Medicine during the period of 2004-2007. Their APACHE II and III scores were estimated within 24 hours before CRRT, and their risk coefficient of mortality was also assessed. The software SPSS 15.0 was used for statistical evaluation. Measurement data were shown as X±S, Chi-square test was used for ratio comparison, and one sample t test was used for comparison among groups. P<0.05 was considered to be significant. Multinomial logistic regression was applied to explore the risk factors. Results A total of 86 post-operation patients under CRRT were studied, with the age of 62.2±16.2yrs, 57 males and 29 females, and 54 patients treated in ICU. Thirty-three cases underwent heart surgery including valvular surgery 13 cases and coronary arterial surgery 19 cases, and all of them were complicated with surgery-related acute kidney injury. Twenty-three cases had operations pertinent to general surgery, 18 cases treated with transplantation operations including liver transplantation 16 cases and renal transplantation 2 cases, 6 cases underwent thoracic operation including esophageal operation and pulmonectomy, and 7 cases had operations due to trauma including neurosurgery 5 cases and other operations 2 cases. Of them 29 cases survived, with the mortality rate of 66.3%. The average APACHE II score was 26.3±7.2 in the 86 cases, in which the score was 23.0±5.8 in survival cases and was 27.9±7.3 in dead cases (P<0.01). The average APACHE III score was 67.4±18.0 in the 86 cases, in which the score was 60.0±14.8 in survival cases and was 71.2±18.4 in dead cases (P<0.01). Logistic regression analysis showed that mechanical ventilation (P=0.000) and multiple organ dysfunction syndrome (P=0.033) were the risk factors for the mortality in patients after surgery and treated with CRRT. Conclusion The prognosis of the patients after surgery and treated with CRRT is closely related to APACHE score, with the higher mortality rate in patients with higher score. APACHE score may be useful for the early prediction of mortality in these patients. One of the two APACHE scoring systems is sufficient for the prediction. Patients complicated with multiple organ dysfunction syndrome or treated with mechanical ventilation are at higher risk of mortality

Key words: Risk factor, Continuous renal replacement therapy, APACHE score

徐静沈平雁马晓波陈晓农张文. 手术后连续性肾脏替代治疗患者急性生理学与慢性健康状况评分效果及高危因素分析[J]. , 2011, 10(6): 298-301.

XU Jing;SHEN Ping-yan;MA Xiao-bo;CHEN Xiao-nong;ZHANG Wen. The risk factors and the acute physiology and chronic health evaluation (APACHE) scores in post-operation patients treated with continuous renal replacement therapy[J]. , 2011, 10(6): 298-301.