Cleveland评分和SRI评分对于择期不停跳冠状动脉旁路移植术后急性肾功能损伤预测价值的探讨

摘要

Objective:To investigate the predictive value of Cleveland score and SRI score for acute kidney injury( AKI )in patients after elective off-pump coronary artery bypass grafting( OPCAB ).rnMethods:We retrospectively studied 288 patients who underwent elective OPCAB from September 2009 to August 2010 in our hospital. The patients were divided into two groups,AKI group,n = 55 and Non-AKI group,n = 233. The patients' clinical data was collected, Cleveland and SRI scores and classifications were studied and compared between two groups. Multivariable logistic regression analysis was performed to evaluate the predictive value for AKI of both scores.rnResults:Compared with Non-AKI group, the patients in AKI group had higher Cleveland score & classification, P=0. 037. Multivariable logistic regression analysis indicated that Cleveland classification was a independent risk factor of AKI( OR 6. 850, 95% CI 1. 365 ~34. 365,P=0. 019 ),AKI group also had higher SRI score and classification;upon elevated AKI level,there were no obvious changes of Cleveland and SRI scores and classifications, P>0. 05. Either Cleveland or SRI scores had no predictive value for low risk AKI after OPCAB. SRI score had good predictive value for continuous renal replacement therapy( CRRT )after 0P-CAB( C 0. 831,95% CI 0. 716 ~0. 946,P=0. 023 ).rnConclusion: Cleveland and SRI scores had no real predictive value for AKI in patients after low risk elective OPCAB. SRI score had good predictive value for CRRT.%目的:探讨Cleveland评分和SRI评分对于择期不停跳冠状动脉旁路移植术后相关急性肾功能损伤(AKI)的预测价值.方法:选取2009-09至2010-08在我科行择期不停跳冠状动脉旁路移植术的病例,搜集住院期间资料及探讨Cleveland评分和SRI评分,验证上述评分系统对于术后相关急性肾功能损伤的预测价值.结果:共入选288例病例,术后AKI发生率19.1%(55/288),分为AKI组,另233例为非AKI组.AKI组Cleveland评分和分级均显著高于非AKI组(P=0.037),差异有统计学意义;多因素分析亦提示Cleveland分级是术后AKI的独立危险因素[比值比(OR)6.850,95%可信区间1.365~34.365,P=0.019].AKI组SRI分级高于非AKI组;随着AKI分级的提高,Cleveland和SRI评分均呈现升高趋势,但差异无统计学意义(P>0.05).Cleveland评分系统和SRI评分系统对于低风险择期不停跳冠状动脉旁路移植术后AKI无明显预测价值(Cleveland评分C值0.560,95%可信区间0.480~0.640;SRI评分C值0.564,95%可信区间0.477~0.651),但SRI评分对于术后接受肾脏替代治疗风险有很好的预测能力(C值0.831,95%可信区间0.716~0.946,P=0.023).结论:Cleveland评分系统和SRI评分系统对于低风险择期不停跳冠状动脉旁路移植术后AKI无明显预测价值,但SRI评分对于术后接受肾脏替代治疗风险有较好的预测价值.