EuroSCORE与SinoSCORE对冠状动脉旁路移植术后患者早期生命质量的预测价值

Role of Euro SCORE and Sino SCORE in prediction of early postoperative quality of life in patients after coronary artery bypass surgery

目的:探讨欧洲心脏外科手术风险评估系统(European system for cardiac operative risk evaluation,Euro SCORE)与中国冠状动脉旁路移植手术评分系统(sino system for coronary operative risk evaluation,Sino SCORE)对冠状动脉旁路移植术后患者早期生命质量的预测价值。方法:连续选择2010年3月至2013年1月在北京大学第三医院心外科接受冠状动脉旁路移植术的218例患者,术前分别以Euro SCORE和Sino SCORE进行手术风险评价,术前及术后3个月以简明健康调查量表进行生命质量调查,分析不同评分系统对术后早期生命质量的预测价值。校准度采用Hosmer-Lemeshow拟合优度检验评价,分辨力采用ROC曲线下面积(AUC)评价。结果:除疼痛与心理功能两个维度外,患者的手术风险评分与术后早期生命质量存在一定相关性(r=-0.493^-0.203,P<0.05)。Logistic回归显示,患者手术风险评分高是术后生命质量低于平均水平的危险因素(OR>1.0,P<0.05),并且Euro SCORE的OR值高于Sino SCORE。Sino SCORE模型Hosmer-Lemeshow拟合优度检验P=0.628,AUC=0.754;Euro SCORE模型Hosmer-Lemeshowrny拟合优度检验P=0.538,AUC=0.854。结论:Euro SCORE和Sino SCORE对冠状动脉旁路移植术患者术后早期生命质量的某些方面具有一定的预测价值,并且Euro SCORE的预测价值可能更高。

Objective： To investigate the predicting value of European system for cardiac operative risk evaluation（ Euro SCORE） and sino system for coronary operative risk evaluation（ Sino SCORE） in early quality of life of patients after coronary artery bypass surgery（ CABG）. Methods： A total of 218 consecutive patients who underwent CABG from March 2010 to January 2013 were evaluated with both systems before operation. Health related quality of life（ Qo L） was estimated by using 36-item short form health survey（ SF-36） preoperatively and postoperatively in order to evaluate the predicting value of the two systems in early post-operative Qo L. Calibration was evaluated by Hosmer-l,emeshow goodness-of-fit test.Discrimination was tested by determining the area under the receiver operating characteristic（ ROC）curve. Results： There was no significant difference between the accumulation of the Euro SCORE and Sino SCORE in the all patients（ t =- 0. 904,P = 0. 368）,When using Wilcoxon test on life quality in the preoperative and postoperative patients respectively,the data showed that the quality of life improved significantly in various dimensions of the postoperative patients（ Z =- 2. 886,P〈0. 001）. Except for bodily pain（ BP） and mental health（ MH）,statistically significant correlation was found between the preoperative risk evaluation scores and the postoperative Qo L scores（ r：- 0. 203 to- 0. 493,P〈0. 05）.Logistic regression analyses indicated that both the scores emerged as the independent predictor for a relatively worse Qo L（ OR 1,P〈0. 05）. Furthermore,the Euro SCORE predicted the outcome with a higher OR. For Sino SCORE the Hosmer-Lemeshow test was significant（ P = 0. 628） and the area under ROC curve was 0. 754. For the Euro SCORE the Hosmer-Lemeshow test was significant（ P = 0. 538） and the area under ROC curve was 0. 854. Conclusion： Both Euro SCORE and Sino SCORE could be viewed as a predictor for several aspects of postoperative Qo L,while Euro SCORE might have a greater predicting value.