ACC评分对动脉调转术后患儿早期预后的评估效果

Evaluation of Aristotle Comprehensive Complexity Score for Early Prognosis in Patients After Arterial Switch Operation

目的:ACC(Aristotle comprehensive complexity score)评分系统是近年来开始应用于先天性心脏病手术难度评估的工具,能够预测先天性心脏病患儿术后早期死亡率和病残率。本文目的在于探讨ACC评分对动脉调转术(ASO)后患儿早期预后的评估效果。方法:回顾性研究我院2008-01至2010-01小儿外科中心ASO手术患儿171例。计算所有患儿ACC分值,分析ACC评分对ASO术后患儿死亡率及快速康复治疗的影响,以线性回归分析ACC评分与机械通气时间、重症监护病房(ICU)住院时间的关系。结果:171例患儿ACC评分结果为12.44±2.33(10～21.5,中位数13),死亡人数7例。171例患儿中,6例ACC评分大于20,死亡5例。23例快速康复治疗患儿ACC评分<13,快速康复患儿与非快速康复患儿ACC评分比较,差异有统计学意义(P=0.006)。ACC评分与机械通气时间呈明显正相关(相关系数8.03,R2=0.921,P=0.000)。结论:ACC评分与ASO患儿术后早期死亡率以及机械通气时间呈明显正相关,ACC评分大于20的患儿死亡率高,应积极降低其非手术依赖风险。

Objective：Aristotle comprehensive complexity （ACC）score is a risk stratification model to assess the surgical technical com- plexity in patients with congenital heart disease which can predict the early mortality and morbidity for certain procedures. Our work intended to explore ACC score for early prognosis in patients after arterial switch operation（ASO）. Methods： We retrospectively studied 171 pediatric patients who underwent ASO in our hospital from 2008 to 2010 ,we calcu- lated their ACC score and studied the effect of ACC score for the mortality and fast recovery rate after ASO, and performed linear regression analysis to calculate the correlations between ACC score and the mechanical ventilation time,length of stay in ICU. Results ： The mean A CC Score was 12.44 ±2. 33 （ 10 - 21.5, at the median of 13 ）. Overall mortality was 7/171. There were 6 patients with ACC score〉 20 and 5 of them died. 23 patients with ACC score〈13 who had fast recovery after ASO. There was sig- nificant difference of ACC score between the patients with and without fast recovery, P = 0. 006. The ACC score was positively related to mechanical ventilation time （ correlation coefficient 8.03, R^2 = 0. 921, P = 0. 000）. Conelusion：ACC score is positively correlated to early death and the mechanical ventilation time in pediatric patients with ASO. The patients with ACC score〉20 could have higher mortality, great effort should be made to decrease the non-surgically dependent risk factors.