EuroSCORE Ⅱ预测A型主动脉夹层患者孙氏手术后院内死亡及住ICU时间延长的有效性研究  

Validation of European System for Cardiac Operative Risk Evaluation Ⅱ in Predicting the Mortality and Prolonged Intensive Care Unit Stay after Sun's Procedure for Stanford Type A Aortic Dissection

作　　者：葛翼鹏[1] 陈雷[1] 里程楠[1] 夏瑀[1] 郭世超[1] 刘巍[1] 朱俊明[1] 刘永民[1] 孙立忠[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2015年第1期23-27,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：首都行业基金专项资助(2011-2006-05);公益性行业科研专项(201402009)~~

摘　　要：目的评估欧洲心脏手术风险评估系统Ⅱ(European System for Cardiac Operative Risk EvaluationⅡ,Euro SCOREⅡ)预测A型主动脉夹层患者孙氏手术(全主动脉弓置换+支架象鼻手术)后院内死亡及住ICU时间延长的有效性。方法回顾性分析2009年2月至2012年2月北京安贞医院384例A型主动脉夹层患者的临床资料。急性主动脉夹层228例(59.38%)。根据Euro SCOREⅡ预测术后死亡率将患者分为低危、中危、高危、极高危组。低危组296例(女52例),平均年龄(45.39±10.75)岁;中危组70例(女19例),平均年龄(47.67±11.26)岁;高危组13例(女5例),平均年龄(53.08±4.94)岁;极高危组5例(女1例),平均年龄(41.60±11.08)岁。手术方式均为中度低温停循环+选择性脑灌注下行孙氏手术。采用Euro SCOREⅡ预测患者术后死亡率及住ICU时间延长。结果院内死亡率为8.07%(31/384)。平均住ICU时间为3.06 d,42例住ICU时间≥7 d。对于低危组,Euro SCOREⅡ预测死亡率低于实际死亡率;对于中危、高危、极高危组,预测死亡率高于实际死亡率。Euro SCOREⅡ预测术后死亡、住ICU时间延长的区分度不佳,ROC曲线下面积分别为0.49和0.52,预测术后死亡、住ICU时间延长校正能力亦不佳(P<0.001)。结论 Euro SCOREⅡ对A型主动脉夹层患者孙氏手术后院内死亡及住ICU时间延长的预测效能不佳。目前亟需专门针对A型主动脉夹层手术的风险评估系统。Objective To evaluate the validity of European System for Cardiac Operative Risk Evaluation（Euro SCORE） Ⅱ for predicting in-hospital mortality and prolonged ICU stay after Sun＇s procedure（total aortic arch replacement with stented elephant trunk implantation） for Stanford type A aortic dissection（STAAD）. Methods Clinical data of 384 STAAD patients undergoing Sun＇s procedure in Beijing Anzhen Hospital between February 2009 and February 2012 were retrospectively analyzed, including 228（59.38%） patients with acute STAAD. Accoding to Euro SCORE Ⅱ to predict postoperative mortality, all the patients were divided into a low-risk group, a medium-risk group, a high-risk group and an extremely-high-risk group. There were 296 patients including 52 females in the low-risk group with their age of 45.39±10.75 years, 70 patients including 19 females in the medium-risk group with their age of 47.67±11.26 years, 13 patients including 5 females in the high-risk group with their age of 53.08±4.94 years, and 5 patients including 1 female patient in the extremely-high-risk group with their age of 41.60±11.08 years. All the patients received Sun＇s procedure under deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. Euro SCORE Ⅱ was used to predict postoperative mortality and prolonged ICU stay. Results In-hospital mortality was 8.07%（31/384）. Mean length of ICU stay was 3.06 days. Length of ICU stay of 42 patients was longer than 7 days. For low-risk group, the predicted mortality was lower than the actual mortality. For medium-risk, high-risk and extremely-high-risk groups, the predicted mortalitywas higher than the actual mortality. Euro SCORE Ⅱ showed unsatisfactory discriminatory ability to predict postoperative mortality and prolonged ICU stay. The area under ROC curve were 0.49 and 0.52 respectively. The calibration was also poor for predicting postoperative mortality and prolonged ICU stay（P0.001）. Conclusions Euro SCORE Ⅱ is not satisfactory for predicting

关 键 词：欧洲心脏手术风险评估系统Ⅱ 死亡率 主动脉夹层 重症监护病房 

分 类 号：R654.3[医药卫生—外科学]