SinoSCORE对老年心血管外科病人的手术风险预测作用

Validation of the Chinese system for cardiac operative risk evaluation （SinoSCORE） in senior heart surgery patients

目的 评价中国冠状动脉旁路移植手术风险评分系统（SinoSCORE）在预测老年病人心脏手术后院内死亡的临床应用价值.方法 从2004年1月到2008年12月,数据库共纳入了来自中国的43个不同的医学中心的9445例65岁以上的老年病人,比较该组病人术前风险因子与SinoSCORE的来源数据库的术前风险因子的区别.通过计算每例病人的SinoSCORE累计积分,分别评价SinoSCORE对该组病人院内病死率的区分度和校准度.结果 老年病人的年龄、性别、慢性肺病、外周血管病、病变冠脉支数、合并肺高压及合并瓣膜手术较SinoSCORE来源数据库差异有统计学意义,但SinoSCORE仍可以很好地预测老年病人的院内病死率,模型表现出很好的校准度（Hosmer-Lemeshow拟合优度检验,P=0.45）和区分度（ROC曲线下面积,0.73,P＜0.01）.结论 SinoSCORE可以用来预测老年病人心脏外科手术后院内死亡.

Objective To validate of the Chinese system for cardiac operative risk evaluation （SinoSCORE） in senior heart surgery patients. Methods Data from 43 Chinese Medical Centers in the period January 2004 through December 2008 were analyzed on 9445 heart surgery patients aged over 65 years. Firstly, risk factors of this series and database of SinoSCORE were compared. Then, the additive score of each patients and the discrimination and calibration of sinoSCORE in elder patients were calculated. Results There were significant differences between the risk factors of patients from two groups. Howerever,the SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination （ Hosmer-Lemeshow test,P =0.45 ） and calibration （the area under the receiver operating characteristic curve, 0.73, P 〈 0.01 ）. Conclusion SinoSCORE was able to predict the in-hospital mortality of senior heart surgery patients.