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目的探讨重症监护室(ICU)患者并发急性肾功能衰竭(ARF)的特点及对其预后的评估。方法回顾性收集2004年12月至2005年4月广东省人民医院ARF患者的临床资料,并对每例患者入住ICU24h内进行APACHEⅡ、SAPSⅡ、SOFA和ATN-ISI评分,分析影响患者预后的危险因素。结果ICU患者并发ARF41例,占同期ICU患者的19.1%,其中死亡21例(51.2%),机械通气比例65.9%,血管活性药物使用率46.3%,少尿发生率41.5%,平均器官衰竭数目2.16个。APACHEⅡ积分17.3分、SAPSⅡ积分52.0分、SOFA积分9.26分、ATN-ISI积分0.54分。Cox回归分析显示,器官衰竭数目和机械通气是ARF患者ICU28d死亡的危险因素,RR值分别为2.54[95%可信区间1.316~4.913)(P=0.006)]和6.0[95%可信区间1.102~32.600(P=0.038)]。ROC曲线分析显示,APACHEⅡ、SAPSⅡ、SOFA和ATN-ISI4个积分系统在预测ARF患者病死率时均有意义,曲线下的面积分别为0.848[95%可信区间0.722~0.974(P<0.001)]、0.880[95%可信区间0.767~0.994(P<0.001)]、0.851[95%可信区间0.726~0.976(P<0.001)]和0.956[95%可信区间0.896~1.026(P<0.001)]。结论重症监护室患者并发ARF时预后差;器官衰竭数目和机械通气是ARF患者死亡的独立危险因素;A-PACHEⅡ、SAPSⅡ、SOFA和ATN-ISI4种积分模型对ARF患者的病死率均有较好的预示作用,ATN-ISI的预测效果可能最优。
Objective To investigate the characteristics of patients with intensive care unit (ICU) complicated with acute renal failure (ARF) and evaluate their prognosis. Methods The clinical data of ARF patients from Guangdong Provincial People’s Hospital from December 2004 to April 2005 were retrospectively collected. APACHEⅡ, SAPSⅡ, SOFA and ATN-ISI scores were recorded within 24 hours of ICU admission in each patient, and the risk factors affecting the prognosis were analyzed . Results The ICU patients complicated with ARF were 41 cases, accounting for 19.1% of the ICU patients in the same period, including 21 deaths (51.2%), 65.9% of mechanical ventilation, 46.3% of vasoactive drugs, 41.5% of oliguria and 2.16 of average organ failure A APACHE II points 17.3 points, SAPS Ⅱ points 52.0 points, SOFA points 9.26 points, ATN-ISI points 0.54 points. Cox regression analysis showed that the number of organ failure and mechanical ventilation were risk factors for ICU28d death in patients with ARF, with RRs of 2.54 [95% confidence interval 1.316-4.913 (P = 0.006)] and 6.0 [95% confidence interval 1.102 ~ 32.600 (P = 0.038)]. The ROC curve analysis showed that 4 APACHEⅡ, SAPSⅡ, SOFA and ATN-ISI scoring systems were all significant in predicting ARF mortality. The areas under the curve were 0.848 [95% CI 0.722-0.974 (P <0.001)] , 0.880 [95% confidence interval 0.767-0.994 (P <0.001)], 0.851 [95% confidence interval 0.726-0.976 (P <0.001)] and 0.956 [95% confidence interval 0.896-1.026 (P <0.001) ]. Conclusions The prognosis is poor in intensive care unit patients with ARF. The number of organ failure and mechanical ventilation are independent risk factors of ARF. The integral models of A-PACHEⅡ, SAPSⅡ, SOFA and ATN-ISI are better for patients with ARF The predictive effect of ATN-ISI may be the best.