Objective To determine the extent to which differences in generic quality of life （QOL） between transcatheter aortic valve implanta- tion （TAVI） and surgical aortic valve replacement （AVR） patients explained by ...Objective To determine the extent to which differences in generic quality of life （QOL） between transcatheter aortic valve implanta- tion （TAVI） and surgical aortic valve replacement （AVR） patients explained by EuroSCORE and heart-team operability assessment. Methods A total of 146 high-risk patients with EuroSCORE 〉 6 and aged 〉 75 years underwent TAVI （n = 80） or aortic valve replacement （n = 66） between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EUroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration. Results The AVR group required longer ventilation （〉 24 h） （TAVI 5.0% vs. AVR 20.6%, P = 0.004） and more units of red blood cells [TAVI 0 （0-1） vs. AVR 2 （0-3）, P = 0.01]. New renal failure was higher in TAVI （TAVI 5.0% vs. AVR 0%, P = 0.06）. TAVI patients reported significantly lower vitality （P = 0.01） by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% （general health） - 62.9% （physical role）] whereas deterioration in QOL occurred less frequently [range 9.3% （physical role） - 33.3% （mental health）]. Conclusions Clinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.展开更多
目的探讨欧洲心脏手术危险因素评价系统(European system for cardiac operative risk evaluation,EuroSCORE)评分指导下非体外循环冠状动脉旁路移植(OPCABG)术前预防性应用主动脉内球囊反搏(IABP)的临床效果,评价术后院内死亡的影响因...目的探讨欧洲心脏手术危险因素评价系统(European system for cardiac operative risk evaluation,EuroSCORE)评分指导下非体外循环冠状动脉旁路移植(OPCABG)术前预防性应用主动脉内球囊反搏(IABP)的临床效果,评价术后院内死亡的影响因素。方法对我院2014年6月至2018年9月在OPCABG中应用IABP的146例患者的临床资料进行回顾分析。根据EuroSCORE分值分为A组(评分<6分,95例)、B组(评分≥6分,51例)。比较两组术前基线资料、IABP应用情况、呼吸支持时间、ICU时间、术后住院时间、病死率等;采用logistic多因素回归分析评价术后院内死亡的影响因素。结果①两组患者年龄、女性、左室射血分数、左主干病变、3支以上病变、不稳定型心绞痛、EuroSCORE评分等指标差异均有统计学意义(P均<0.05)。②B组IABP预防时间>2h患者的例数多于A组,IABP运转时间、呼吸支持时间、ICU时间长于A组(P均<0.05)。两组在备改转比例、总住院时间、术后住院时间、IABP有关并发症、院内死亡比例、1年内死亡比例等方面差异均无统计学意义(P均>0.05)。结论高龄、女性、左主干病变、低射血分数、急诊手术为患者院内死亡的危险因素,IABP使用为院内死亡的保护因素。EuroSCORE高危患者OPCABG术前预防性应用IABP可降低院内死亡率,IABP并发症发生的风险并未加大,可在临床推广应用。展开更多
目的评价Logistic Euro SCORE与Euro SCOREⅡ风险预测模型对本中心成人单纯二尖瓣置换术后在院死亡率预测的准确性。方法回顾性收集2009年1月至2013年12月497例患者在院接受单纯二尖瓣置换术的临床资料,包括同期行三尖瓣成形、左房减容...目的评价Logistic Euro SCORE与Euro SCOREⅡ风险预测模型对本中心成人单纯二尖瓣置换术后在院死亡率预测的准确性。方法回顾性收集2009年1月至2013年12月497例患者在院接受单纯二尖瓣置换术的临床资料,包括同期行三尖瓣成形、左房减容、左心耳闭合术患者。其中男性186例,女性311例,平均(53.19±11.11)岁。按照第一版的Logistic Euro SCORE模型与新版的Euro SCOREⅡ模型给予评分获得患者的预测死亡率,与患者的实际在院死亡率比较。模型预测的符合程度应用Hosmer-Lemeshow拟和优度检验,而预测的鉴别效度则通过受试者工作特征曲线(ROC)下面积反映。结果497例患者在院死亡6例,全组实际在院死亡率为1.21%,logistic Euro SCORE及Euro SCOREⅡ预测的在院死亡率分别为2.99%和1.53%。其中Euro SCOREⅡ对全组患者在院死亡率预测符合程度较高,而logistic Euro SCORE明显高估了在院死亡率。logistic Euro SCORE的区分度及校准度差(P=0.673,AUC=0.621),Euro SCOREⅡ区分度及校准度均较好(P=0.894,AUC=0.793)。结论 Euro SCOREⅡ对本中心单纯二尖瓣置换手术患者在院死亡风险预测的准确性较高。展开更多
文摘Objective To determine the extent to which differences in generic quality of life （QOL） between transcatheter aortic valve implanta- tion （TAVI） and surgical aortic valve replacement （AVR） patients explained by EuroSCORE and heart-team operability assessment. Methods A total of 146 high-risk patients with EuroSCORE 〉 6 and aged 〉 75 years underwent TAVI （n = 80） or aortic valve replacement （n = 66） between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EUroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration. Results The AVR group required longer ventilation （〉 24 h） （TAVI 5.0% vs. AVR 20.6%, P = 0.004） and more units of red blood cells [TAVI 0 （0-1） vs. AVR 2 （0-3）, P = 0.01]. New renal failure was higher in TAVI （TAVI 5.0% vs. AVR 0%, P = 0.06）. TAVI patients reported significantly lower vitality （P = 0.01） by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% （general health） - 62.9% （physical role）] whereas deterioration in QOL occurred less frequently [range 9.3% （physical role） - 33.3% （mental health）]. Conclusions Clinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.
文摘目的探讨欧洲心脏手术危险因素评价系统(European system for cardiac operative risk evaluation,EuroSCORE)评分指导下非体外循环冠状动脉旁路移植(OPCABG)术前预防性应用主动脉内球囊反搏(IABP)的临床效果,评价术后院内死亡的影响因素。方法对我院2014年6月至2018年9月在OPCABG中应用IABP的146例患者的临床资料进行回顾分析。根据EuroSCORE分值分为A组(评分<6分,95例)、B组(评分≥6分,51例)。比较两组术前基线资料、IABP应用情况、呼吸支持时间、ICU时间、术后住院时间、病死率等;采用logistic多因素回归分析评价术后院内死亡的影响因素。结果①两组患者年龄、女性、左室射血分数、左主干病变、3支以上病变、不稳定型心绞痛、EuroSCORE评分等指标差异均有统计学意义(P均<0.05)。②B组IABP预防时间>2h患者的例数多于A组,IABP运转时间、呼吸支持时间、ICU时间长于A组(P均<0.05)。两组在备改转比例、总住院时间、术后住院时间、IABP有关并发症、院内死亡比例、1年内死亡比例等方面差异均无统计学意义(P均>0.05)。结论高龄、女性、左主干病变、低射血分数、急诊手术为患者院内死亡的危险因素,IABP使用为院内死亡的保护因素。EuroSCORE高危患者OPCABG术前预防性应用IABP可降低院内死亡率,IABP并发症发生的风险并未加大,可在临床推广应用。
文摘目的评价Logistic Euro SCORE与Euro SCOREⅡ风险预测模型对本中心成人单纯二尖瓣置换术后在院死亡率预测的准确性。方法回顾性收集2009年1月至2013年12月497例患者在院接受单纯二尖瓣置换术的临床资料,包括同期行三尖瓣成形、左房减容、左心耳闭合术患者。其中男性186例,女性311例,平均(53.19±11.11)岁。按照第一版的Logistic Euro SCORE模型与新版的Euro SCOREⅡ模型给予评分获得患者的预测死亡率,与患者的实际在院死亡率比较。模型预测的符合程度应用Hosmer-Lemeshow拟和优度检验,而预测的鉴别效度则通过受试者工作特征曲线(ROC)下面积反映。结果497例患者在院死亡6例,全组实际在院死亡率为1.21%,logistic Euro SCORE及Euro SCOREⅡ预测的在院死亡率分别为2.99%和1.53%。其中Euro SCOREⅡ对全组患者在院死亡率预测符合程度较高,而logistic Euro SCORE明显高估了在院死亡率。logistic Euro SCORE的区分度及校准度差(P=0.673,AUC=0.621),Euro SCOREⅡ区分度及校准度均较好(P=0.894,AUC=0.793)。结论 Euro SCOREⅡ对本中心单纯二尖瓣置换手术患者在院死亡风险预测的准确性较高。
