摘要
目的对4437例心脏瓣膜置换手术病人进行回顾性研究，定量评估住院死亡的危险凶素，建立瓣膜置换手术住院死亡风险模型，以及安贞医院瓣膜置换手术风险评分系统。方法选取安贞医院心脏外科数据库中收录的主动脉瓣置换术病人848例，二尖瓣置换术病人2202例，主动脉瓣、二尖瓣双瓣膜置换术病人1387例。选取术前、术中33个临床指标作为住院死亡的可能影响因素，利用单闳素分析进行筛选，然后利用多因素分析确立3种手术的住院死亡危险因素并建市风险模型。结果经多因素分析，年龄、体表面积、心功能分级、术前肌酐和体外循环时间是主动脉瓣置换术住院死亡的危险因素。心功能分级、术前心衰史、心胸比率、短轴缩短率、病因、左心室收缩末径，体外循环时间和术中IABP是二尖瓣置换术住院死亡的危险因素。年龄、心功能分级、术前心内膜炎、糖尿病史、既往二尖瓣球囊扩张术、体重指数和体外循环时间是主动脉瓣、二尖瓣双瓣膜置换术的住院死亡危险因素。ROC曲线下面积分别为主动脉瓣置换术模型0．921（95％CI，0．874～0．967），二尖瓣置换术模型0．859（95％CI，0．813—0．905），主动脉瓣、二尖瓣双瓣膜置换术模型0．868（95％CI，0．827～0．908）。Hosmer—Lemeshow检验显示，主动脉瓣置换术模型χ^2=1．463，P=0．993，二尖瓣置换术模型χ^2=8．720，P=0．366，主动脉瓣、二尖瓣双瓣膜置换术模型χ^2=8．134，P=0．420，预计病死率与实际观测病死率筹异无统计学意义。结论3个模型能够定量评估瓣膜置换术病人住院死亡风险。
Objective Background Predicting risk factors for valve replacements is important both for informed consent of patients and objective review of surgical outcomes. Development of reliable prediction rules requires large data sets with appropriate risk factors that are available before surgery. Methods Data were from Beijing Anzhen Institute of heart, pulmonary and vascular diseases in the period of January 1993 to December 2004. 4482 heart valve replacement patients were analyzed. There were 848 aortic valve replacements, 2202 mitral valve replacements and 1387 double valve replacements, Logistie regression was used to examine the relationship between risk factors and in-hospital mortality. Results In the muhivariable analysis, 5 variables in the aortic model （older age, body area, NYHA class Ⅳ, ereatin, CPB time） , 8 variables in the mitral model （ NYHA class Ⅳ, congestive heart failure, cardiac/thoracic ratio, FS, etiology, LVESD, CPB time, use of IABP） and 7 variables in the double valve model （older age, NYHA class Ⅳ, previous myocarditis, diabetes, CPB time, weight index, previous pereutaneous mitral balloon valvotomy） remained independent predictors of the outcome. The mathematical models were highly significant predictors of the in-hospital mortality, and the results were in general agreement with those of others. The area under the receiver operating characteristic curve for the aortic, model was 0. 921 [ 95% confidence interval （ CI ）, 0. 874 to 0. 967], for the mitral model was 0. 859 （95% CI, 0. 813 to 0. 905 ） and for double model was 0. 868 （95% CI, 0. 827 to 0.908）. The goodness-of-fit statistie for the aortic model wasχ^2 = 1.463, P =0.993, for the mitral model wasχ^2 = 8.720, P = 0. 366 and for the double valve model wasχ^2 = 8 . 134, P = 0. 420. Conclusion We present results and methods for use in day-to-day practice to calculate patient-specific in-hospital mortality after aortic and mitral valve surgery, by the logistic equation fur each model or a simple scoring
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2010年第1期8-12,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏瓣膜假体植入
危险因素
模型
统计学
Heart valve prosthesis implantation Risk factor Models, statistical
