低手术量心脏外科中心瓣膜手术风险评估系统的应用评价
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摘要
目的评价STS风险评估系统、EuroSCOREⅡ、SinoSCORE、安贞风险评估系统对本中心心脏瓣膜手术患者术后死亡风险适用程度。方法收集了2010—2015年行心脏瓣膜置换手术患者共226例的临床资料,按照上述4个风险评估系统分别计算各患者的预期死亡风险,运用AU-ROC评价各模型的区分度,将患者分成低危、中危、高危3组并采用Homser-Lemeshow(HL)卡方检验对模型进行校准。结果安贞风险评估系统、STS风险评估系统、EuroSCOREⅡ、SinoSCORE的AU-ROC值分别为0.912±0.030,0.791±0.067,0.680±0.057,0.807±0.078;校准度H-L检验P值分别为0.471,0.039,0.012,0.343。结论相比国外的STS风险评估系统及EuroSCOREⅡ,安贞风险评估系统及SinoSOCRE更适宜于本中心心脏瓣膜手术的风险评估,可在低手术量心脏中心推广。
Objective It is to evaluate the applicability of the STS risk assessment system, EuroSCORE Ⅱ, SinoSCORE, and Anzhen risk assessment system to the risk of postoperative death in patients undergoing heart valve surgery. Methods The clinical data of 226 patients undergoing heart valve replacement surgery in our hospital from 2010 to 2015 were collected. The expected risk of death was calculated according to the above four risk assessment systems. The discrimination of each model was evaluated by AU-ROC. The patients were divided into low-risk, intermediate-risk, and high-risk groups and the models were calibrated using the Homser-Lemeshow(HL) chi-square test. Results The AU-ROC valuesof the Anzhen risk assessment system, STS risk assessment system, EuroSCORE Ⅱ, and SinoSCORE were 0.912±0.030; 0.791±0.067; 0.680±0.057; 0.807±0.078, respectively, the P value of calibration degree H-L test were 0.471, 0.039, 0.012, 0.343 respectively. Conclusion Compared with the foreign STS risk assessment system and EuroSCORE Ⅱ, the Anzhen risk assessment system and SinoSOCRE are more suitable for the risk assessment of heart valve surgery in our center, which can be promoted in the low-operative heart center.
Objective It is to evaluate the applicability of the STS risk assessment system, EuroSCORE Ⅱ, SinoSCORE, and Anzhen risk assessment system to the risk of postoperative death in patients undergoing heart valve surgery. Methods The clinical data of 226 patients undergoing heart valve replacement surgery in our hospital from 2010 to 2015 were collected. The expected risk of death was calculated according to the above four risk assessment systems. The discrimination of each model was evaluated by AU-ROC. The patients were divided into low-risk, intermediate-risk, and high-risk groups and the models were calibrated using the Homser-Lemeshow(HL) chi-square test. Results The AU-ROC valuesof the Anzhen risk assessment system, STS risk assessment system, EuroSCORE Ⅱ, and SinoSCORE were 0.912±0.030; 0.791±0.067; 0.680±0.057; 0.807±0.078, respectively, the P value of calibration degree H-L test were 0.471, 0.039, 0.012, 0.343 respectively. Conclusion Compared with the foreign STS risk assessment system and EuroSCORE Ⅱ, the Anzhen risk assessment system and SinoSOCRE are more suitable for the risk assessment of heart valve surgery in our center, which can be promoted in the low-operative heart center.
引文
[1]赵举,黑飞龙,中国生物医学工程学会体外循环分会.2015中国心脏外科和体外循环数据白皮书[J].中国体外循环杂志,2016,14(3):130-132
[2]O’Brien SM,Shahian DM,Filardo G,et al.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 2-isolated valve surgery[J].Ann Thorac Surg,2009,88(1 Suppl):S23-42
[3]Shahian DM,Edwards FH.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:introduction[J].Ann Thorac Surg,2009,88(1 Suppl):S1
[4]Shahian DM,O’Brien SM,Filardo G,et al.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 3-valve plus coronary artery bypass grafting surgery[J].Ann Thorac Surg,2009,88(1 Suppl):S43-62
[5]Shahian DM,O’Brien SM,Filardo G,et al.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 1-coronary artery bypass grafting surgery[J].Ann Thorac Surg,2009,88(1 Suppl):S2-22
[6]Nashef SA,Roques F,Sharples LD,et al.Euro SCORE II[J].Eur J Cardiothorac Surg,2012,41(4):734-744
[7]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估[J].中华心血管病杂志,2010,38(10):901-904
[8]白涛,孟旭,张兆光.4437例瓣膜置换术住院死亡危险因素分析及安贞风险评分系统建立[J].中华胸心血管外科杂志,2010,26(1):8-12
[9]Wang C,Li X,Lu FL,et al.Comparison of six risk scores for in-hospital mortality in Chinese patients undergoing heart valve surgery[J].Heart Lung Circ,2013,22(8):612-617
[10]Wang L,Lu FL,Wang C,et al.Society of Thoracic Surgeons 2008 cardiac risk models predict in-hospital mortality of heart valve surgery in a Chinese population:a multicenter study[J].J Thorac Cardiovasc Surg,2014,148(6):3036-3041
[11]Wang C,Tang YF,Zhang JJ,et al.Comparison of four risk scores for in-hospital mortality in patients undergoing heart valve surgery:A multicenter study in a Chinese population[J].Heart Lung,2016,45(5):423-428
[12]Wang C,Jin L,Qiao F,et al.Performance of The Society of Thoracic Surgeons 2008 Cardiac Risk Models for Major Postoperative Complications after Heart Valve Surgery in a Chinese Population:A Multicenter Study[J].Heart Surg Forum,2018,21(4):e281-e285
[13]Nishida T,Sonoda H,Oishi Y,et al.The novel Euro SCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic Euro SCORE algorithms[J].Interact Cardiovasc Thorac Surg,2014,18(4):446-450
[14]张蔚然,邵永丰,张杨杨,等.Sino SCORE和Euro SCOREⅡ对老年冠状动脉旁路移植术患者死亡风险预测的价值[J].江苏医药,2014,40(13):1517-1519
[15]中国心血管外科注册登记研究协作组.Sino SCORE预测瓣膜手术死亡风险[J].中华胸心血管外科杂志,2011,27(2):81-83
[16]钱永军,张尔永,安琪,等.Sino SCORE对成人心脏手术后院内死亡风险的预测---中国成人心脏外科数据库华西医院数据报告[J].中国胸心血管外科临床杂志,2012,19(4):362-365
[17]王崇,韩林,陆方林,等.Sino SCORE预测瓣膜手术在院死亡风险---第二军医大学长海医院胸心外科经验[J].中华胸心血管外科杂志,2013,29(4):193-195
[18]阎岩,王律,韩林,等.Sino SCORE对心脏瓣膜术后院内死亡及并发症的预测价值[J].第二军医大学学报,2013,34(2):172-176
[19]王崇,韩林,张冠鑫,等.心脏瓣膜手术在院死亡风险预测模型及评分标准的建立[J].中国胸心血管外科临床杂志,2011,18(1):2-10
[2]O’Brien SM,Shahian DM,Filardo G,et al.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 2-isolated valve surgery[J].Ann Thorac Surg,2009,88(1 Suppl):S23-42
[3]Shahian DM,Edwards FH.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:introduction[J].Ann Thorac Surg,2009,88(1 Suppl):S1
[4]Shahian DM,O’Brien SM,Filardo G,et al.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 3-valve plus coronary artery bypass grafting surgery[J].Ann Thorac Surg,2009,88(1 Suppl):S43-62
[5]Shahian DM,O’Brien SM,Filardo G,et al.The Society of Thoracic Surgeons 2008 cardiac surgery risk models:part 1-coronary artery bypass grafting surgery[J].Ann Thorac Surg,2009,88(1 Suppl):S2-22
[6]Nashef SA,Roques F,Sharples LD,et al.Euro SCORE II[J].Eur J Cardiothorac Surg,2012,41(4):734-744
[7]郑哲,张路,胡盛寿.中国冠状动脉旁路移植手术风险评估[J].中华心血管病杂志,2010,38(10):901-904
[8]白涛,孟旭,张兆光.4437例瓣膜置换术住院死亡危险因素分析及安贞风险评分系统建立[J].中华胸心血管外科杂志,2010,26(1):8-12
[9]Wang C,Li X,Lu FL,et al.Comparison of six risk scores for in-hospital mortality in Chinese patients undergoing heart valve surgery[J].Heart Lung Circ,2013,22(8):612-617
[10]Wang L,Lu FL,Wang C,et al.Society of Thoracic Surgeons 2008 cardiac risk models predict in-hospital mortality of heart valve surgery in a Chinese population:a multicenter study[J].J Thorac Cardiovasc Surg,2014,148(6):3036-3041
[11]Wang C,Tang YF,Zhang JJ,et al.Comparison of four risk scores for in-hospital mortality in patients undergoing heart valve surgery:A multicenter study in a Chinese population[J].Heart Lung,2016,45(5):423-428
[12]Wang C,Jin L,Qiao F,et al.Performance of The Society of Thoracic Surgeons 2008 Cardiac Risk Models for Major Postoperative Complications after Heart Valve Surgery in a Chinese Population:A Multicenter Study[J].Heart Surg Forum,2018,21(4):e281-e285
[13]Nishida T,Sonoda H,Oishi Y,et al.The novel Euro SCORE II algorithm predicts the hospital mortality of thoracic aortic surgery in 461 consecutive Japanese patients better than both the original additive and logistic Euro SCORE algorithms[J].Interact Cardiovasc Thorac Surg,2014,18(4):446-450
[14]张蔚然,邵永丰,张杨杨,等.Sino SCORE和Euro SCOREⅡ对老年冠状动脉旁路移植术患者死亡风险预测的价值[J].江苏医药,2014,40(13):1517-1519
[15]中国心血管外科注册登记研究协作组.Sino SCORE预测瓣膜手术死亡风险[J].中华胸心血管外科杂志,2011,27(2):81-83
[16]钱永军,张尔永,安琪,等.Sino SCORE对成人心脏手术后院内死亡风险的预测---中国成人心脏外科数据库华西医院数据报告[J].中国胸心血管外科临床杂志,2012,19(4):362-365
[17]王崇,韩林,陆方林,等.Sino SCORE预测瓣膜手术在院死亡风险---第二军医大学长海医院胸心外科经验[J].中华胸心血管外科杂志,2013,29(4):193-195
[18]阎岩,王律,韩林,等.Sino SCORE对心脏瓣膜术后院内死亡及并发症的预测价值[J].第二军医大学学报,2013,34(2):172-176
[19]王崇,韩林,张冠鑫,等.心脏瓣膜手术在院死亡风险预测模型及评分标准的建立[J].中国胸心血管外科临床杂志,2011,18(1):2-10