多器官衰竭评分和序贯衰竭评分系统对心脏手术后风险评估的比较

Evaluation MODS and SOFA postoperative score system for cardiac surgery Department of Cardiovascular Surgery

目的:比较多器官衰竭评分(multiple organ dysfunction score,MODS)和序贯衰竭评分系统(sequential organ failure assessment,SOFA)对心脏手术后风险进行评估的价值。方法:2007年10月至2008年4月,对北京安贞医院心脏外科监护室每天收治的18岁以上心脏手术后的患者共1 935例,男性1 050例,女性885例。采用MODS和SOFA系统进行评分,比较这2个系统对心脏手术后风险评估的价值。分别计算这2个系统的手术当日分值、最大分值、3 d内最大分值,第3日与第1日分值差,并计算它们ROC曲线下面积。结果:MODS系统的当日分值、最大分值、3 d内最大分值、第3日与第1日分值差的ROC曲线下面积分别为(0.747,0.901,0.892及0.786),SOFA系统分别为(0.736,0.891,0.880及0.798)。结论:MODS和SOFA系统都可以用于心脏外科手术后风险评估,但MODS对死亡的风险评估优于SOFA系统。

Objective：To compare sensitivity and specificity of MODS and SOFA score system in predicting prognosis after cardiac operation.Methods： A prospective study of 1935 consecutive patients entering in a single cardiac postoperative intensive care unit of Anzhen hospital was assigned between October,2007 and May,2008.MODS、SOFA score was calculated daily at least three days or until death,then compared the receiver operating characteristic（ROC） curve of the two system at different time.Results： ROC value of the first day after operation was（MODS 0.747,SOFA 0.736）,ROC of the maximal score point（MODS 0.901,SOFA 0.891）,ROC of the maximal score point during the first 3 days（MODS 0.892,SOFA 0.880）,ROC of the change score point between the third day value and the first day value（MODS 0.786,SOFA 0.798）.Conclusion： The MODS and SOFA score system were feasible to predict risk after cardiac operation,but the sensitivity and specificity of MODS score was better than SOFA score in prediction of mortality and morbidity after cardiac surgery.