欧洲评分Ⅱ预测Stanford A型主动脉夹层患者孙氏手术后中期生存率的有效性

摘要

Objective EuroSCORE is a widely used objective risk scoring model.The aim of this study was to evaluate the validation of EuroSCORE Ⅱ in predicting mid-term survival after total aortic arch replacement with stented elephant trunk implantation(sun' s procedure) for Stanford Type A aortic dissection.Methods Total 90 patients entered the study randomly.All the patients underwent aortic surgery using total aortic arch replacement with stented elephant trunk implantation (Sun's procedure).The patients were divided into three groups based on the predicting mortality by EuroSCORE Ⅱ.Ggroup 1:0 ＜:P ≤ 5 ％,Group 2:5 ％ ＜ P ≤ 10％,Group 3:P ＞ 10％.Kaplan-Meier method was used to evaluate the long term survival of three groups.Receiver operating characteristic curve was used to test discrimination of the EuroSCORE.Calibration was assessed with a Hosmer-Lemeshow goodness-offit statistic.Results 87 patients were followed umil October,2013.The mean follow-up time was(33.32 ± 11.11) months.Total 5 patients died during the follow-up time.Three patients died in group 1,2 patients died in group 2 and 1 in group 3.There was no statistical difference for the mid-term survival rate between 3 groups (P =0.054).Conclusion Although EuroSCORE Ⅱ is the newest risk model for cardiac surgery,it is not accurate when it is applied for predicting mid-term survival after aortic surgery.A new risk evaluating system specially designed for aortic surgery should be developed in the future.%目的 评估欧洲评分Ⅱ能否有效预测A型主动脉夹层患者孙氏手术后的中期生存率.方法 90例行孙氏手术的A型主动脉夹层患者使用随机号码表法随机纳入研究.欧洲评分Ⅱ计算患者预测死亡概率(P),根据死亡概率将患者分为3组,组1:0＜P≤5％.组2:5％＜P≤10％,组3:P＞10％.分别计算并比较3组患者的中期生存率.评估方法采用Kaplan-Meier生存分析法.欧洲评分的区分能力采用受试者工作特征曲线评价,校正能力采用Hosmer-lemeshow拟合优度评价.结果 截至2013年10月,随访87例,失访3例.随访时间(33.32±11.11)个月.死亡5例,组1 3例,组21例,组3 1例.Kaplan-Meier生存分析法3组生存率差异无统计学(P =0.054).欧洲评价预测术后生存的ROC曲线下面积0.37,Hosmer-leneshow拟合优度不佳(P＜0.05).结论 虽然欧洲评分Ⅱ在心血管外科领域是最新升级且应用最为广泛的风险评估系统,但其对A型主动脉夹层患者孙氏手术后中期生存率的预测效能不佳.未来需要一种专门预测主动脉手术患者预后的评分系统.