床边工具用于预测心脏手术患者手术后透析的风险
Rajendra H Mehta1, Joshua D Grab, Sean M O'Brien
1Duke Clinical Research Institute, Durham, NC 27715, USA. mehta007@dcri.duke.edu
Circulation
|November 8, 2006
概括
一个新的风险评分识别了心脏手术后需要透析的患者. 该工具帮助临床医生与患者讨论术后透析风险,改善决策.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 术后透析风险估计对于临床决策和患者咨询至关重要.
- 心脏手术患者面临的风险是需要在手术后进行透析.
研究的目的:
- 开发一种简单,准确的床边风险算法,用于预测心脏手术后需要透析的情况.
- 在接受冠状动脉旁路移植和/或门手术的患者中确定术后透析的关键预测因素.
主要方法:
- 从胸部外科医生协会国家数据库中评估了449524名接受心脏手术 (2002-2004) 的患者的数据.
- 利用后勤回归来确定手术后透析的主要预测因素.
- 在86,009名患者的独立队列中验证了开发的风险评分.
主要成果:
- 术后透析是1.4%的心脏手术患者需要的.
- 确定的主要预测因素包括手术前血清肌素,年龄,种族,手术类型,糖尿病,休克,NYHA类,肺部疾病,最近的心肌梗塞和之前的心血管手术.
- 风险评分在各种心脏手术类型中显示出强大的预测准确性 (c-统计值=0.83).
结论:
- 确定了心脏手术后术后透析的主要患者风险因素.
- 基于这些因素,开发了一个简单而准确的床边风险工具.
- 预计该工具将增强临床医生与患者关于术后透析风险的讨论.
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