EuroSCORE评分对心脏瓣膜手术患者死亡风险的预测

摘要

Objective To evaluate the accuracy of European System for Cardiac Operative Risk Evaluation( EuroSCORE) in predicting in-hospital mortality of patients undergoing cardiac valve surgery under extracorporeal circulation. Methods Clinical data of 134 patients undergoing cardiac valve surgery under extracorporeal circulation in The Third People’s Hospital of Chengdu from December 2011 to March 2015 was collected. All patients were assessed using additive EuroSCORE and logistive EuroSCORE before surgery and were divided into low-risk group,moderate-risk group and high-risk group according to the additive EuroSCORE. Then we compared the predictive and practical mortality of all the 134 patients and the three subgroups. And the postoperative complications, the residence time of CSICU,practical mortality and predictive mortality were also compared among the three subgroups. We used the Speaman correlation analysis to analyze the correlation of EuroSCORE and postoperative complication,residence time of ICU,practical mortality. At the same time,Receiver Operating Characteristic( ROC) Curve was used to evaluate the accuracy of additive EuroSCORE and logistic EuroSCORE. Results The additive EuroSCORE, logistic EuroSCORE, postoperative complications, residence time of ICU,practical mortality were significantly different,when comparing high-risk group with moderate-risk group,and moderate-risk group with low-risk group(P<0. 05). And the practical mortality and predictive mortality also demonstrated difference in the full set and the three subgroups,with statistic significance(P<0. 01). The Speaman correlation coefficients of EuroSCORE and postoperative compli-cations,residence time of ICU,practical mortality were all less than 0. 5. And the respective under ROC curve area of additive Eu-roSCORE and logistic EuroSCORE was less than 0. 70. Conclusion EuroSCORE was not fit for preoperative assessment of patients undergoing cardiac valve surgery.%目的：评估欧洲心脏手术风险评分系统( EuroSCORE)预测体外循环下心脏瓣膜手术患者在院死亡率的准确性。方法收集我院2011年12月至2015年3月体外循环下行心脏瓣膜手术的患者134例,对所有患者进行术前ad-ditive EuroSCORE及logistic EuroSCORE评分,并根据additive EuroSCORE评分分成低危组、中危组、高危组。比较全组及各亚组患者的实际及预测死亡率；比较不同亚组的术后并发症、CSICU滞留时间、实际死亡率、预期死亡率；利用speaman相关系数分析Euroscore评分与术后并发症、icu滞留时间的、实际死亡率的相关性；应用受试者工作特征( ROC)曲线评估additive EuroSCORE及logistic EuroSCORE评分的准确性。结果高危组与中危组、中危组与低危组比较, additive Eu-roSCORE评分、logistic EuroSCORE评分、术后并发症,ICU 滞留时间、实际死亡率差异均有统计学意义( P<0．05)；全组及亚组预测死亡率及实际死亡率差异有统计学意义( P<0．01)；additive及logistic EuroSCORE评分对应的术后并发症、ICU滞留时间、实际死亡率的Speaman相关系数( r)均小于0．5；additive 及logistic EuroSCORE评分对应的实际死亡率的ROC曲线下面积均小于0．70。结论 EuroSCORE评分系统不适合于心脏瓣膜手术患者的术前评估。