探讨SinoSCORE系统对非体外循环下冠状动脉旁路移植术风险评估的价值  

Risk Level Evaluation of SinoSCORE System in Patients With Off-Pump Coronary Artery Bypass Grafting

作　　者：郑宝荣[1] 王联群[2] 刘建实[2] 郭志刚[2] 姜楠[2] 张金芳[1] 王金江[1] 

机构地区：[1]天津静海县医院外一科,天津市301600 [2]天津市胸科医院心外科

出　　处：《中国循环杂志》2013年第5期375-378,共4页Chinese Circulation Journal

摘　　要：目的：通过SinoSCORE系统将接受冠状动脉旁路移植术（CABG）患者分为低危、中危、高危三组，比较非体外循环下冠状动脉搭桥术（OPCAB）的早期效果，探讨该系统对OPCAB风险的评估。方法：连续收集我院2010—01至2011-08施行单独OPCAB患者1347例围手术期资料，年龄36—81岁（61．33±7．74）岁。应用SinoSCORE系统将全部患者分为三组：低危组（评分≤1分，n=724），中危组（评分2～5分，n=436），高危组（评分≥6分，n=187），将患者的术前、术中资料和术后早期效果进行比较。结果：高危组患者与低危组比较，重症监护病房（ICU）的监护时间较长，延长辅助通气时间和延长重症监护病房监护时及死亡的发生率均较多，差异有统计学意义（P=0．002）。中危组和高危组患者比低危组的主动脉球囊反搏及正性肌力药的使用率、脑卒中、肾功能衰竭、二次气管插管的发生率均增加，心房颤动的发生率较低，差异有统计学意义（P〈0．05）。1347例患者术后死亡12例。低危组死亡1例，中危组死亡5例，高危组死亡6例。高危组与低危组比较死亡率较高，差别有统计学意义（P=0．001）。结论：运用SinoSCORE系统将高风险冠心病患者与中危组患者相比，同样能够较好的接受OPCAB，获得较满意的临床效果，SinoSCORE系统能够较好的区分不同层次的病例，并预测低危组、中危组与高危组的手术疗效。Objective： To evaluate the risk levels of SinoSCORE system for peri-operative conditions in patients with off-pump coronary artery bypass grafting （OPCABG）. Methods： We retrospectively evaluated 1347 patients with OPCABG in our hospital from January 2010 to August 2011. The patients were at the age of 36～81 （61.33 ± 7.74） years and divided into 3 groups as Low risk group, SinoSCORE ≤ 1, n=724, Moderate risk group, SinoSCORE 2～5, n=436 and High risk group, SinoSCORE ≥6, n=187. The clinical conditions before the operation and at the early post operative stage were compared among different groups. Results： Compared with Low risk group, High risk group had more patients with prolonged ICU stay, longer mechanical ventilation time aub higher mortality, P=0.002. Compared with Low risk group, the Moderate risk group and High risk group had increased incidences of intra-aortic balloon counter pulsation （IABP）, positive inotropic medication, more chest infection, post-operative stroke, renal failure, and secondary tracheal intubation, while had lower incidence of atrial fibrillation P〈0.05. There were 12/1347 post operative death, and 1 in Low risk group, 5 in Moderate risk group and 6 in High risk group. High risk group had more mortality than Low risk group, P〈0.05. Conclusion： SinoSCORE system may better stratify the risk levels and predict the early OPCABG outcomes in patients with the low, moderate and high risks respectively.

关 键 词：非体外循环 冠状动脉旁路移植术 高危患者 SinoSCORE系统 

分 类 号：R541[医药卫生—心血管疾病]