多器官衰竭评分系统及其修正法在心脏手术后的使用价值

Evaluation of MODS score system and its modified system for the postoperative patients with cardiac surgery

目的:探讨简便易行、适用于心脏外科的、行之有效的心脏手术评分系统。方法:2007年10月至2008年4月期间,每日对北京安贞医院心脏外科监护室收治的年满18岁的心脏手术后患者(共1 935例)进行多器官衰竭评分(mutiple organ dysfunction score,MODS)和MODS修正法评分,每个患者至少连续评分3日,或直到死亡,或痊愈离开监护室,比较两种方法对手术风险评估的敏感性和特异性。结果:按照MODS和MODS修正法两种不同的评分方法,分别计算手术当日分值、最大分值、3日内最大分值、第3日与第1日分值差,比较两种评分系统在不同时间段的受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积,包括手术当日分值的ROC值:MODS 0.742,MODS修正法0.810;最大分值的ROC值:MODS 0.896,MODS修正法0.901;3日内最大分值ROC值:MODS 0.886,MODS修正法0.896;第3日与第1日分值差的ROC值:MODS 0.777,MODS修正法0.808。结论:MODS及其修正法都可以用于心脏手术后的风险评估,MODS修正法对风险评估的敏感性和特异性要优于MODS。

Objective：To establish a feasible postoperative score system for cardiac surgery patients.Methods： A prospective study was assigned of the 1 935 consecutive patients entering a single cardiac postoperative intensive care unit of Anzhen Hospital between Octorber,2007 and January,2008.Mutiple organ dysfunction score（MODS score） and modified mutiple organ dysfunction score（modified MODS score） were calculated daily at least three days,or until intensive care discharge or death.MODS score and modified MODS score of the first day,maximum MODS and modified MODS scores during the first 3 days,and maximal MODS and modified MODS scores,MODS score and modified MODS score changes between the first and the third postoperative day were calculated,then the sensitivity and specificity of the two score systems were compared by the receiver operating characteristic curve（ROC）.Results： ROC of the operative day score： MODS was 0.742,and modified MODS was 0.810;ROC of the maximum score： MODS was 0.896,and modified MODS was 0.901;ROC of the maximum scores during the first three： MODS was 0.886,and modified MODS was 0.896;ROC of the change between the third day and the first day score： MODS was 0.777,and modified MODS was 0.808.Conclusion： Both MODS score system and modified MODS score system are feasible to evaluate the patient＇s prognosis after cardiac surgery,and the sensitivity and specificity of modified MODS score system are better than those of MODS score system.