2种欧洲心脏手术风险评估系统评分对冠状动脉旁路移植术风险的预测价值

Two European cardiac operative risk evaluation systems for predicting postoperative risks in coronary artery bypass grafting patients

目的冠状动脉旁路移植术(coronary artery bypass graft,CABG)术前风险评估对手术治疗方案的选择及预后预测有重要指导意义。文中旨在探讨2种欧洲心脏手术风险评估系统(European system for cardiac operative risk evaluation,Eu-roSCORE)评分对CABG术后患者早期死亡率及并发症的预测价值。方法 CABG患者212例,收集整理EuroSCORE全部危险因子的详细数据,进行Additive与logistic评分。按Additive Euro SCORE分值将患者分为高风险组:61例,男51例,女10例,平均年龄为(72.9±6.3)岁;中风险组:90例,男73例,女17例,平均年龄为(68.8±7.5)岁;低风险组:61例,男54例,女7例,平均年龄为(58.4±5.8)岁。统计出患者实际死亡率和主要并发症的发生率,采用受术者特征(receiver operating charac-teristic,ROC)曲线评价2种EuroSCORE的预测价值,logistic回归分析EuroSCORE与术后发生并发症之间的关联。结果观察期(1个月)内共死亡7例患者,实际总死亡率3.3%,预测总死亡率Additive EuroSCORE为4.2%,logistic EuroSCORE为4.3%,高度风险组实际死亡率为8.2%,预测值分别为7.5%和9.1%;中度风险组实际死亡率为2.3%,预测值分别为3.9%和3.1%;低度风险组实际死亡率为0,预测值分别为1.1%和1.3%。Additive EuroSCORE与logistic EuroSCORE的ROC曲线下面积分别为0.837和0.840。logistic回归分析显示,logistic EuroSCORE与术后各系统发生并发症有更好的相关性,较Addi-tive EuroSCORE优越。结论 Additive评分和logistic评分均对CABG患者术后死亡危险具有较好的预测和估计作用,但两者之间在危险程度的判断上无显著差异。同时,logistic评分对于多种并发症具有较好的预测作用,可作为术前准备、手术决策的重要依据。

Objective Risk evaluation before coronary artery bypass grafting （CABG） is important for the making of the operation plan and prognosis.This study was to verify the value of two European systems for cardiac operative risk evaluation （EuroSCORE） in predicting early mortality and complications in CABG patients.Methods We collected and analyzed the detailed data of 212 cases of CABG on the EuroSCORE risk factors based on the score of Additive EuroSCORE,and divided the patients into a high-risk group （n= 61,51 males,10 females,aged [72.9 ± 6.3] yr）,a medium-risk group （n = 90,73 males,17 females,aged [68.8 ± 7.5] yr） and a low-risk group （n = 61,54 males,7 females,aged [58.4 ± 5.8] yr）.We assessed the value of Additive EuroSCORE and logistic EuroSCORE in predicting mortality and postoperative complications using the receiver operating characteristic （ROC） curve,and detected the association of the two models with postoperative complications by logistic regression analysis.Results Seven deaths occurred during 30 days of postoperative observation,with a mortality of 3.3%,as compared with 4.2% and 4.3% predicted by the Addictive and logistic EuroSCORE,respectively.The actual mortality was 8.2% in the high-risk group against 7.5% and 9.1% predicted by the two systems,2.3% in the medium-risk group against 3.9% and 3.1%,and 0% in the low-risk group against 1.1% and 1.3%.The area under the ROC curve was 0.837 for the Additive and 0.840 for the logistic model.logistic regression analysis suggested a positive correlation of logistic EuroSCORE with postoperative complications.Conclusion Both the Addictive and logistic systems may well predict postoperative mortality of patients undergoing CABG,with no significant differences between,and the latter is superior in predicting postoperative complications.EuroSCORE may provide important information for surgical determination,operative planning and prognosis before CABG.