EuroSCORE评分对心脏瓣膜手术预后的评估作用.docVIP

【摘要】 目的：研究欧洲心脏手术风险评分系统 EuroSCORE 在心外科重症监护病房中对心脏瓣膜手术预后的评估价值。方法：对本中心2007年1月1日至2007年12月31日期间连续施行单纯心脏瓣膜手术277例的患者进行术前EuroSCORE评分，并根据累积 additive EuroSCORE评分病人被分成低 0～2分，79例 、中 3～5分，140例 、高危3组 ≥6分，58例 。比较3组间术后死亡率，严重并发症发生率及术后重症监护病房入住天数。应用受试者工作特征 ROC 曲线分析及Spearman相关系数分析EuroSCORE评分与死亡率，严重并发症及入住心脏外科监护病房 CICU 天数的相关性。结果：全组共死亡6例，其中高危组5例 8.6% 高于中危组的1例 0.7% 及低危组 0 ，P 0.01。高危组严重并发症发生率 46.6% 显著高于中危组 8.6% 及低危组 1.3% ，P均 0.01。术后低、中、高危组CICU入住天数分别为 1.38±0.63 d， 2.26±1.31 d和 5.98±4.20 d，三组间比较有显著差异 P 0.01 。与累积 additive 及Logistic EuroSCORE分值对应的术后严重并发症的ROC下面积分别为0.820和0.836 P 0.001 ，对应的死亡率的ROC下面积分别为0.875和0.875 P 0.01 。累积和Logistic EuroSCORE与术后CICU入住天数Spearman相关系数 r 分别为0.678和0.698 P 0.001 。低、中危组的预期死亡率显著高于实际死亡率 P 0.01 。结论：EuroSCORE评分系统总体上可较好地评估单纯心脏瓣膜手术风险。对于预期死亡率在高危组与实际死亡率相近，在低、中低危组高于实际死亡率。 【关键词】 心脏瓣膜疾病;心脏外科手术;危险性评估 　Effect of EuroSCORE for the risk evaluation in the heart valve surgery/YOU Hao，LIAO Chongxian，YANG Qian，SHAN Zhonggui，ZHAO Xia，LIN Zhi，GUO Hongwei//Chinese Journal of Cardiovascular Rehabilitation Medicine,2009,18 5 :483 　　Abstract：Objective:The European system for cardiac operative risk evaluation EuroSCORE is a very useful preoperative risk stratification system in cardiac surgery.The aim of this study was to evaluate the validity of EuroSCORE in isolated heart valve surgery.Methods:Data were collected from 277 consecutive adult patients who received isolated heart valve surgery between January 1st and December 31st 2007 in our department.Additive and Logistic EuroSCORE for every patient were calculated.According to additive EuroSCORE，the patients were categorized into L-group low risk group，an additive EuroSCORE of 0～2 ，M-group medium risk group，an additive EuroSCORE of 3～5 and H-group high risk group，an additive EuroSCORE of ≥6 .The mortality，the rate of severe postoperative complication and the length of stay in cardiac intensive care units CICU were compared among three groups.Receiver operating characteristic ROC curve was used to assess the discriminatory abili