SinoSCORE评估冠状动脉旁路移植术后患者死亡风险的价值  

The Evaluative Value of SinoSCORE on the Risk of Death in Patients Undergoing Coronary-artery Bypass Graft

作　　者：于泉[1] 王云[2] 顾继伟[2] 郭飞杰[2] 姜博[1] 张玉京[1] 

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院心脏外科,银川750004

出　　处：《宁夏医科大学学报》2013年第4期412-414,423,共3页Journal of Ningxia Medical University

摘　　要：目的研究SinoSCORE对冠状动脉旁路移植术患者术后死亡风险的预测价值。方法回顾性分析523例冠状动脉旁路移植手术患者的临床资料,用SinoSCORE评分法则进行评分并预测其死亡人数,采用Homser-Lemeshow拟合优度检验评价模型的预测能力。据患者术前状况按SinoSCORE评分,可分为低危(≤1分)、中危(2～5分)、高危(≥6分)三组,运用受试者工作特征(ROC)曲线下面积检验模型的区分度。结果 523例病人中19例发生院内死亡,实际死亡率3.63%,SinoSCORE模型预测的死亡率为1.74%,其中低危、中危组患者采用本模型计算得到的预期死亡人数与实际死亡人数较吻合。介于本研究样本例数相对中国心血管外科注册登记系统中统计的病例数(尤其高危病人)较少,患者年龄、手术方式、人群构成比及围术期影响因素情况分布相对不均衡,因此研究结果中预测高危组病人死亡率有一定的差异,SinoSCORE模型的Hosmer-Lemeshow拟合优度检验P=0.438(χ2=4.368),ROC曲线下面积为0.79(95%置信区间0.714～0.831),其校准度和区分度良好。结论 SinoSCORE评分系统具有良好的评估冠状动脉旁路移植术患者死亡风险的价值,能够为冠状动脉旁路移植手术风险评估提供指导。Objective To explore the evaluative value of SinoSCORE on the death risk in patients undergoing coronary-artery bypass graft. Methods The clinical material of 523 patients undergoing coronary artery by-pass graft were retrospectively analyzed. The death toll were forecased with SinoSCORE rating score and , the prediction abilityof the model was evaluated with the Homser - Leineshow goodness - of - fit tes. According to the SinoSCORE, the patients can be divided into low - risk （ 1 piont or less）, intermediate - risk （ 2 - 5 points）, high - risk （ six points or more）. The receiver - operating Characteristic （ROC） was used to test the discrimination of the model. Results 19 cases happened nosocomial death in all 523 cases of patients. The actual fatality was 3.63% while SinoSCORE modelexpected fatality was 1.74%. The expected death toll and the real death toll of low - risk and intermediate - risk group showed consistent. Hosmer - LeIneshow good-ness - of - fit test of SinoSCORE model P = 0. 438 （ X^2 = 4.368）, the ROC curve area was 0.79 （95% confi-dence interval, 0. 714 to 0. 831 ）. Calibration degree and discrimination degree were good. Conclusion Si-noSCORE has a good value on evaluating the risk of death in patients undergoing coronary artery bypass graft. SinoSCORE can provide guidance to coronary artery bypass graft surgery risk assessment.

关 键 词：冠状动脉旁路移植术 SINOSCORE 死亡风险 

分 类 号：R654.2[医药卫生—外科学]