中文摘要：

目的：急性肾损伤是心脏术后常见且严重的并发症.本研究针对2012 KDIGO指南的AKI标准,比较了RI-FLE、AKIN、KDIGO三种诊断标准对心脏术后AKI的诊断效率及各自的危险因素.方法：选取长海医院胸心外科2012年手术患者221例,记录年龄、性别、术前基础疾病及用药情况,术前1天肾功能为基线值、记录手术方式、体外循环时间,随访术后30 d,记录肾功能进展、并发症、住院时间及透析、死亡情况.结果：患者221例,男121例（54.7％）,年龄55岁～75岁,中位数61岁,其中糖尿病占16.7％,高血压40.7％,术前血肌酐（80±31.2）μmol/L,GFR 75.2 ml/min.手术后应用RIFLE、AKIN、KIDIGO三种标准诊断,AKI的发病率分别为19％、30.8％、23.1％.在危险因素分析中,发现年龄、联合手术、体外循环时间、低心排综合征是独立危险因素.在单变量COX回归分析中,进行年龄、性别、糖尿病、低心排调整后,KDIGO诊断AKI的风险比HR1.88（1.18 ～3.10）,对预后预测能力强于RIFLE和AKIN标准.结论：AKI的发病率随诊断标准的不同变化极大,本研究发现,KDIGO指南的AKI诊断标准对预后的预测能力强于RIFLE和AKIN标准.

英文摘要：

Objective：acute kidney injury is the most common and serious complication in patients undergoing cardiac surgery.To evaluate the incidence and risk factors for the development of AKI following cardiac surgery according to the RIFLE,AKIN and KDIGO criteria,and compare the prognostic power of these critera.Methods：Patients undergoing cardiac surgery from January 2012 to January 2013 in changhai hospital were retrospectively evaluated.Record age,sex,preoperative underlying disease and drug use,baseline renal function,operation style,the time of extracorporeal circulation,and fowllowing 30days to record sugery complication and renal function.Results：two hundred twenty one patients were included in this study.It conclude 121 males （54.7％）,median age 61 （55 ～75） years,of which 16.7％ diabetes,hypertension 40.7％,preoperative serum creatinine （80 ± 31.2） μmol/L,GFR 75.2 ml/min.We use the RIFLE,AKIN,KIDIGO three diagnositic criteria to evaluate these patients.The AKI incidence rates were 19％,30.8％,23.1％ respectively.In the analysis of risk factors,we found that age,combine surgery,cardiopulmonary bypass time,low cardiac output syndrome is an independent risk factor.In univariate COX regression analysis,for age,gender,diabetes,low cardiac output after adjustment,KDIGO diagnosis of AKI risk ratio HR1.88 （1.18 ～ 3.10）,is the strongest prognostic diagnostic criteria.Conclusion：the incidence and risk factors of AKI after surgery vary significantly according different diagositic criteria.In this study,we found the KDIGO criteria was superior to RIFLE and AKIN criteria in prognostic power.