EuroSCORE Ⅱ和SYNTAX Ⅱ评分对冠状动脉旁路移植手术患者临床结局的预测价值评估  

Evaluation of the predictive value of EuroSCORE Ⅱ and SYNTAX Ⅱ scores for clinical outcomes in patients undergoing CABG

作　　者：熊鑫 李楠 徐一君 陈志强 刘鹏 温文 李晓伟 张小龙 陈杜荣 邓勇志 Xiong Xin;Li Nan;Xu Yjun;Chen Zhiqiang;Liu Peng;Wen Wen;Li Xiaowei;Zhang Xiaolong;Chen Durong;Deng Yongzhi(Deparment of Cardiovascular Surgery,the Afiliated Cardiovascular Hospital of Shanxi Medical University,Shanxi Cardiovascular Hospital(Institute),Shanxi Clinical Medical Research Center for Cardiovascular Disease,Taiyuan 030024,China;Department of Anesthesiology,the Afiliated Cardiovascular Hospial of Shanxi Medical University,Shanxi Cardiovascular Hospital(Institute),Shanxi Clinical Medical Research Center for Cardiovascular Disease,Taiyuan 030024,China;School of Public Health,Shanxi Medical University,Taiyuan 030024,China)

机构地区：[1]山西医科大学附属心血管病医院,山西省心血管病医院(研究所),山西省心血管病临床医学研究中心心脏大血管外科,太原030024 [2]山西医科大学附属心血管病医院,山西省心血管病医院(研究所),山西省心血管病临床医学研究中心麻醉科,太原030024 [3]山西医科大学统计教研室,太原030024

出　　处：《中华胸心血管外科杂志》2024年第8期464-468,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨EuroSCORE Ⅱ和SYNTAX Ⅱ评分对冠状动脉移植手术患者临床结局的预测效能,并探讨患者围术期死亡和术后4年死亡的危险因素。方法选择2014年4月到2023年7月在山西省心血管病医院诊治并进行冠状动脉旁路移植术(CABG)的冠心病患者500例作为研究对象,所有患者均进行EuroSCORE Ⅱ和SYNTAX Ⅱ评分。分别评估EuroSCORE Ⅱ对CABG患者围术期死亡和SYNTAX Ⅱ对CABG患者术后4年死亡的预测价值,并通过logistic单变量和多变量分析,探讨围术期和术后4年死亡的危险因素。结果围术期死亡3例(0.60%,3/500),预测死亡比例1.71%;术后4年死亡21例(4.23%,21/500),预测死亡比例9.02%。Logistic回归分析显示左心室射血分数(LVEF)是患者围术期死亡的唯一独立的保护因素,年龄是患者术后4年死亡的唯一独立危险因素(P<0.05)。受试者工作特征曲线(ROC)分析发现,EuroSCORE Ⅱ对CABG患者围术期死亡预测曲线下面积为0.782,SYNTAX Ⅱ对术后4年死亡预测曲线下面积为0.743。结论EuroSCORE Ⅱ对冠脉旁路移植手术患者围术期死亡和SYNTAX Ⅱ对患者术后4年死亡比例有一定的预测价值,但预测死亡比例偏高。低LVEF和高龄分别是围术期和术后4年死亡的唯一独立危险因素。Objective To explore and analyze the predictive value of EuroSCORE Ⅱ and SYNTAX Ⅱ scores for clinical outcomes in patients undergoing coronary artery bypass grafing(CABG)surgery.Methods A total of 500 coronary artery disease(CAD)patients who underwent CABG in Shanxi Cardiovascular Hospital from April 2014 to July 2023 were selected as the study subjects,all patients were given EuroSCORE Ⅱ and SYNTAX Ⅱ scores to evaluate the predictive value of EuroSCORE Ⅱ for perioperative mortality and SYNTAX Ⅱ for 4-year mortality.Univariate and multivariate Logistic analysis were employed to analyze the independent risk factors for perioperative and 4-year mortality.Results There were 3 deaths during the perioperative period,with a mortality rate of 0.60%,the predicted mortality rate of EuroSCORE Ⅱ was 1.71%;there were 21 deaths at 4 years after surgery,with a mortality rate of 4.23%and the predicted mortality rate of SYNTAX Ⅱ was 9.02%.Logistic regression analysis showed that left ventricular ejection fraction(LVEF)was the only independent protective factor for perioperative mortality,and advanced age was the only independent risk factor for 4-year postoperative mortality in patients(P<0.05).The analysis of the working characteristic curve of the subjects found that the area under the receiver operating characteristic curve(ROC)of EuroSCORE Ⅱ for perioperative mortality was O.782,and the area under ROC curve of SYNTAX Ⅱ for postoperative 4-year mortality was 0.743.Conclusion Both EuroSCORE Ⅱ and SYNTAX Ⅱ have certain predictive value for perioperative mortality and postoperative 4-year mortality in patients undergoing CABG,respectively,but the predicted mortality rate is relatively higher.

关 键 词：冠状动脉粥样硬化性心脏病 冠状动脉旁路移植术 EuroSCOREⅡ评分 SYNATAXⅡ评分 危险因素 

分 类 号：R654.2[医药卫生—外科学]