心脏手术风险评估欧洲系统(EuroSCORE)的初步临床应用

Preliminary experience in application of European system for cardiac operative risk evaluation (EuroSCORE)

目的初步评价心脏手术风险评估欧洲系统(EuroSCORE)的临床应用效果。方法对2004年2￣6月在我科因“冠心病”行手术治疗的51例患者在术前应用EuroSCORE进行风险评估;手术后应用APACHEⅢ、MODS和SOFA对患者进行危重症评估。分析比较术前风险评估和术后危重症评估间的相关关系。结果根据Eu-roSCORE评分分级,本组包括低危(0￣2分)患者6例、中危患者(3￣5分)20例、高危患者(≥6分)25例。全组共13例出现术后并发症,术后早期(<30d)无死亡。StandardEuroSCORE和LogisticEuroSCORE在总体水平上与A1、M1、S1以及Amax、Mmax、Smax呈正相关关系(P<0.01);在不同风险度比较时,仅在高危患者中StandardEuroSCORE与A1、M1、S1以及Amax、Mmax、Smax呈正相关关系(P<0.05)。结论EuroSCORE系统在总体上能够很好地评估手术风险,对高危患者更敏感;但预期死亡率的计算可能需要进一步校正。

Objective To summarize preliminary experience in the application of European system for cardiac operatire risk evaluation. Methods Assess the operative risk preoperatively with EuroSCORE in the patients who was operated for coronary artery disease from Feb 2004 to June 2004 in our ward, and evaluate the postoperative severe states with APACHE Ⅲ, MODS and SOFA. Analysis the correlation of these evaluation systems. Results The patients were divided into three risk ranks according standard EuroSCORE： 6 of low risk （0-2）, 20 of medium risk （3-5） and 25 of high risk （〉16）. 13 patients suffered postoperative complications, but no one died in early stage （〈30 days） postoperative. Both standard EuroSCORE and logistic EuroSCORE had significant positive correlation with either of A1, M1, S1 or Amax, Mmax, Smax （P〈0.01）. When compared the relationships in certain risk ranks, the positive correlation was only found between standard EuroSCORE and A1, M1, S1 or Amax, Mmax, Smax （P〈0.05） in high risk patients. Conclusion EuroSCORE could evaluate overall operative risk perfectly, and maybe more sensitively in high-risk patients. But the calculation to predict mortality should be adjusted.