成人患者术前终末期肝病模型衍生积分与心脏术后体外膜肺氧合辅助急性肾功能损伤的关系

摘要

Objective To retrospect the outcomes of postoperative adult patients in our center and to explore whether there was a correlation between the preoperative MELD-XI score and acute kidney injury (AKI) in adult patients treated with extracorporeal membrane oxygenation (ECMO) so as to determine the risk factors of AKI and the prognosis of those patients. Methods We reviewed181 cases of postoperative patients treated with ECMO from 2012 to 2015 in our center. The preoperative MELD-XI score and the morbidity of AKI after 24 h and 48 h of ECMO running were calculated to explore the possible association. Results There were statistical differences in baseline MELD-XI score, pre-ECMO serum lactic acid level, serum creatinine and urea nitrogen at 24 h and 48 h of ECMO running, RRT treatment and mortality between patients with AKI and patients without AKI, P ＜ 0.05. High MELD-XI score was a predictor of AKI after 48 h of ECMO running. Conclusion Preoperative baseline MELD-XI score can be used to predict the risk of AKI for postoperative patients treated with VA-ECMO. We can calculate the baseline MELD-XI score to evaluate their risk of AKI.%目的 回顾心脏外科术后接受静脉-动脉体外膜肺氧合(V-A ECMO)辅助的成人患者,探寻患者术前终末期肝病模型衍生积分(MELD-XI)与术后急性肾损伤(AKI)是否存在一定联系,以帮助判断V-A ECMO患者的AKI风险及预后.方法 回顾本中心2012年至2015年共181例成人心脏外科术后行V-A ECMO辅助的患者,计算术前MELD-XI评分和ECMO辅助后24 h和48 h的AKI发生情况并分析可能的相关性.结果 发生AKI患者与无AKI患者在入院基线MELD-XI、ECMO前血乳酸、ECMO辅助24 h和48 h的血清肌酐和尿素氮、应用连续性肾脏替代治疗和出院生存率均存在统计学差异(P ＜0.05);高MELD-XI积分是ECMO辅助48 h发生AKI的危险因素.结论 术前基线MELD-XI评分对心脏外科术后接受V-A ECMO患者的AKI风险有预测作用,患者进行V-A ECMO辅助后可及时计算MELD-XI以评估患者发生AKI的风险.