摘要
目的建立冠状动脉旁路移植术患者术后早期死亡预测模型,为提升冠状动脉粥样硬化性心脏病患者的手术质量提供参考.方法对1482例行冠状动脉旁路移植术治疗冠状动脉粥样硬化性心脏病患者的临床资料进行单因素及多因素分析,根据危险因素建立冠状动脉旁路移植术患者术后早期死亡风险评估模型.采用自建冠状动脉旁路移植术患者术后早期死亡风险评估系统及欧洲心脏手术风险评估系统、美国心脏手术风险评估系统对1482例冠状动脉粥样硬化性心脏病患者进行术后早期死亡风险评估,计算每种预测系统的死亡预测率均值;以每种预测方法的预测死亡率与真实死亡率制作ROC曲线,以ROC曲线下面积值评价3种方法预测冠状动脉旁路移植术患者早期死亡风险的能力.结果多因素分析显示,年龄、呼吸系统疾病、外周血管疾病、急性心肌梗死、既往有心血管介入治疗史、心源性休克、主动脉瓣反流、二尖瓣反流等均为冠状动脉旁路移植术患者发生早期死亡的独立危险因素(P<0.05或0.01),评估冠状动脉旁路移植术后患者早期死亡模型公式为:Prob=1/(1+e-x),Z=-4.603+0.894×年龄+1.212×呼吸系统疾病+0.698×外周血管疾病+0.823×急性心梗+1.024×既往心血管介入治疗史+3.485×心源性休克+0.698×主动脉瓣反流+0.704×二尖瓣反流.自建预测模型系统、欧洲心脏手术风险评估系统、美国心脏手术风险评估系统预测冠状动脉旁路移植术患者术后早期死亡风险率分别为2.89%、3.68%、3.74%,ROC曲线下面积分别为0.561、0.497、0.538.结论成功建立国内冠状动脉旁路移植术患者术后早期死亡风险预测模型,该模型对冠状动脉旁路移植术患者术后早期死亡风险预测效果优于欧洲及美国心脏手术风险评估系统.
Objective To establish a model for predicting early postoperative mortality in patients under-going coronary artery bypass grafting,and to provide a reference for improving the surgical quality of pa-tients with coronary atherosclerotic heart disease.Methods The clinical data of 1482 patients undergoing CABG treatment for coronary atherosclerotic heart disease were analyzed by single factor and multi-fac-tors,and the early postoperative mortality risk assessment model of CABG patients was established ac-cording to the risk factors.A self built CABG patient early death risk assessment system and EuroSCORE and STSSCORE were used to evaluate early death risk of 1482 patients with coronary atherosclerotic heart disease.Calculate the average mortality prediction rate for each prediction system.The ROC curve was made with the predicted mortality and the real mortality of each prediction methpd,and the AUC value was used to evaluate the ability of the three methods to predict the early death of patients with coronary ar-tery bypass grafing.Results Multivariate analysis showed that age,respiratory disease,peripheral vas-cular disease,acute myocardial infarction,previous history of cardiovascular interventional therapy,cardiogenic shock,aortic valve regurgitatiom.mitral valve re-gurgitation,etc.were all independent risk factors for early death in CABG patients(P<0.05 or 0.01).The formula for evaluating the early death model of patients after CABG was:Prob=1/(1+e*),Z=-4.603+0.894X age+1.212 X respiratory disease+0.698 X peripheral vascular disease+0.823 X acute myocardial infarction+1.024 X history of previous cardiovascular intervention therapy+3.485 X cardiogenic shock+0.698 X aortic valve regurgitation+0.704 X mitral valve regurgitation.The self-built prediction model system,EuroSCORE,and STSS-CORE predicted the early death risk rates after CABG were 2.89%,3.68%,and 3.74%,and the AUC was 0.561.0.497,and 0.538,respectively.Conclusions The establishment of a domestic model of early postoperative mortality risk prediction for CABG patients has a better predictive effect on the early postop-erative mortality risk of CABG patients than European and American cardiac surgery risk assessment sys-tems.
作者
王艳敏
张悟麟
李桂梅
Wang Yanmin;Zhang Wulin;Li Guimei(Anyang Third People's Hospilal,Anyang 455000,Henan,China)
出处
《临床心身疾病杂志》
CAS
2020年第5期46-50,共5页
Journal of Clinical Psychosomatic Diseases
作者简介
王艳敏,女。52岁,汉族,本科,副主任护师。护理部主任。主要研究成果:发表专业论文10余篇。研究方向:老年疾病护理及医院护理管理。
