EuroSCORE评分对心脏瓣膜手术预后的评估作用  

Effect of EuroSCORE for the risk evaluation in the heart valve surgery

作　　者：尤颢[1] 廖崇先[1] 杨谦[1] 单忠贵[1] 赵霞[1] 林智[1] 郭宏伟[1] 

机构地区：[1]厦门大学附属中山医院心脏外科,福建厦门361004

出　　处：《心血管康复医学杂志》2009年第5期483-486,488,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究欧洲心脏手术风险评分系统(EuroSCORE)在心外科重症监护病房中对心脏瓣膜手术预后的评估价值。方法:对本中心2007年1月1日至2007年12月31日期间连续施行单纯心脏瓣膜手术277例的患者进行术前EuroSCORE评分,并根据累积(additive)EuroSCORE评分病人被分成低(0～2分,79例)、中(3～5分,140例)、高危3组(≥6分,58例)。比较3组间术后死亡率,严重并发症发生率及术后重症监护病房入住天数。应用受试者工作特征(ROC)曲线分析及Spearman相关系数分析EuroSCORE评分与死亡率,严重并发症及入住心脏外科监护病房(CICU)天数的相关性。结果:全组共死亡6例,其中高危组5例(8.6%)高于中危组的1例(0.7%)及低危组(0),P<0.01。高危组严重并发症发生率(46.6%)显著高于中危组(8.6%)及低危组(1.3%),P均<0.01。术后低、中、高危组CICU入住天数分别为(1.38±0.63)d,(2.26±1.31)d和(5.98±4.20)d,三组间比较有显著差异(P<0.01)。与累积(additive)及Logistic EuroSCORE分值对应的术后严重并发症的ROC下面积分别为0.820和0.836(P<0.001),对应的死亡率的ROC下面积分别为0.875和0.875(P<0.01)。累积和Logistic EuroSCORE与术后CICU入住天数Spearman相关系数(r)分别为0.678和0.698(P<0.001)。低、中危组的预期死亡率显著高于实际死亡率(P<0.01)。结论:EuroSCORE评分系统总体上可较好地评估单纯心脏瓣膜手术风险。对于预期死亡率在高危组与实际死亡率相近,在低、中低危组高于实际死亡率。Objective, The European system for cardiac operative risk evaluation （EuroSCORE） is a very useful preoperative risk stratification system in cardiac surgery. The aim of this study was to evaluate the validity of EuroSCORE in isolated heart valve surgery. Methods： Data were collected from 277 consecutive adult patients who received isolated heart valve surgery between January 1st and December 31st 2007 in our department. Additive and Logistic EuroSCORE for every patient were calculated. According to additive EuroSCORE, the patients were categorized into L--group （low risk group, an additive EuroSCORE of 0～2）, M--group （medium risk group, an additive EuroSCORE of 3～5） and H--group （high risk group, an additive EuroSCORE of ≥6）. The mortality, the rate of severe postoperative complication and the length of stay in cardiac intensive care units （CICU） were compared among three groups. Receiver operating characteristic （ROC） curve was used to assess the discriminatory ability of the additive and Logistic EuroSCORE. Correlation between EuroSCORE and CICU stay was also analyzed. Results： The observed mortality was higher in H --group （8. 6%）, compared with that of M--group （0.7%） and L--group （0%） （P〈0.01）. There were no signifi- cant differences in mortality between L--group and M--group. The severe postoperative complication rate of was higher in H--group （46.6%）, compared with M--group （8. 6%） and L--group （1.3%） , P〈0. 01. The length of stay in cardiac ICU of H--group was longer than that of two other groups [ （6.26±4. 02） d vs. （1.38 ± 0.63） d and （2.26± 1.31） d, P〈0.01]. The area under receiver operating characteristic （ROC） curve were 0. 820 （additive） and 0. 836 （Logistic） for the severe complications （P〈0. 001）, 0. 875 （additive） and 0. 875 （Logistic） for mortality （P〈 0.01）. The Spearman correlation coefficients about additive and Logistic EuroSCORE and length of stay in CICU were 0. 678 and 0. 698

关 键 词：心脏瓣膜疾病 心脏外科手术 危险性评估 

分 类 号：R542.2[医药卫生—心血管疾病]