CHADS2及CHA2DS2-VASc评分在冠心病外科治疗中的应用

The application of CHADS2 and CHA2DS2-VASc score in coronary artery bypass surgery

目的 评价CHADS22及CHA2DS2-VASc评分系统在冠心病外科治疗中的意义.方法 选择2006年1月至2010年1月行不停跳冠状动脉旁路移植术的768例患者,术后新发房颤患者97例.回顾患者的围术期及随访资料,应用CHADS2及CHA2DS2-VASc评分系统进行分析.结果 768例患者术后新发房颤发生率12.6％,分为术后新发房颤组与非房颤组.新发房颤组与非房颤组平均年龄分别为（70.74±8.21）岁和（65.90±9.83）岁,围术期脑卒中分别为8例和9例,CHADS2评分值分别为3.20±1.26和2.13±0.94,CHA2DS2-VASc评分值分别为4.20±1.50和3.23±1.07.CHADS2和CHA2DS2-VASc评分是术后新发房颤的预测因素,与围术期脑卒中显著相关（P＜0.01）.结论 冠心病外科治疗中应用CHADS2及CHA2DS2-VASc评分系统可预测术后新发房颤及围术期脑卒中,对冠心病术后新发房颤的抗凝及抗血小板治疗决策提供了依据,对卒中风险及预后有一定的评估价值.

Objective The purpose of this study is to evaluate CHADS2 and CHA2DS2-VASc score in coronary artery bypass surgery. Methods Clinical records of 768 patients who underwent off pump coronary artery bypass grafting surgery were analyzed retrospectively. CHADS2 and CHA2DS2-VASc score have been used in the analysis. Results The patients were divided into two groups： postoperative atrial fibrillation group and non-atrial fibrillation group. The incidence of postoperative atrial fibrillation was 12.6%. The average age was （70.74±8.21） years old and （65.90±9.83）years old, the number of postoperative stroke was 8 and 9, CHADS2 score was 3.20＋ 1.26 and 2.13±0.94, CHA2DS2-VASc score was 4.20±1.50 and 3.23±1.07 respectively. CHADSz and CHA2DS2- VASc scoring were predictors of postoperative atrial fibrillation and were closely associated with perioperaive stroke （P〈0.01）. Conclusion Our results suggest that CHADS2 and CHA2DS2-VASc score are highly reliable in the prediction of postoperative atrial fibrillation as well as perioperative stroke. Therefore, the scoring system is valu- able in anticoagulation and antipIatelet management and prophylactic consideration in coronary artery bypass surgery for atrial fibrillation and stroke. Hence, CHADS2 and CHA2DS2-VASc score system is applicable in clinical prac- tice of coronary artery bypass shrgery.