376例心脏瓣膜手术EuroSCORE高预测风险与低手术死亡率的关系 The Relationship between EuroSCORE High Prediction Risk and Low Operation Mortality in 376 Cases of Heart Valve Operation
目的：分析376例心脏瓣膜置换手术EuroSCORE预测死亡风险和实际死亡率的变化趋势，评价心脏瓣膜置换手术对重症心脏瓣膜病患者的治疗价值。方法：回顾性分析本中心2007年3月至2012年12月376例心脏瓣膜置换手术的临床资料，对比全组病例欧洲心脏手术危险评估系统(EuroSCORE)平均值与手术死亡率的逐年变化趋势。同时将病例分为两组，符合重症心脏瓣膜病诊断标准的纳入重症组，其余患者纳入普通组。统计两组病例的EuroSCORE分值的平均分、手术死亡率、呼吸机辅助时间及并发症发生率(包括围术期心梗、脑卒中、恶性心律失常、急性肾功能衰竭及呼吸功能不全等)，进行组间比较。结果：全部病例EuroSCORE评分平均值从2007年的1.9上升到2012年的5.7，手术死亡率由2007年的3.1%下降至2012年的2.3%。EuroSCORE平均值逐年上升，而手术死亡率略有下降。重症组与普通组EuroSCORE平均值、手术死亡率、并发症率、呼吸机辅助时间等方面比较，差异均有统计学意义(p < 0.05)，但是两组手术死亡率均显著低于预测死亡率。结论：随着手术适应症的不断扩大，我院心脏瓣膜病患者EuroSCORE平均分逐年上升，手术死亡率略有下降。EuroSCORE预测死亡风险显著升高的重症心脏瓣膜病患者经过充分的术前准备、手术技术的完善和发展及严密的围术期监护和治疗，可以降低手术死亡率，改善高预测风险患者的预后。 Objective: To analyze the relationship between EuroSCORE high prediction risk and low operation mortality in 376 cases of cardiac valve replacement, and evaluate the value of heart valve re-placement in the treatment of patients with severe heart valve disease. Methods: 376 cases of heart valve replacement form March 2007 to December 2012 were analyzed retrospectively in our center. The yearly change trends of the average value of the European heart operation risk assessment system (EuroSCORE) and operation mortality were contrasted. Then, the patients were divided into two groups. The severe group was divided with severe heart valve disease diagnosis standard, the remaining patients into common group. The average EuroSCORE, operation mortality, ventilation time, and the incidence of complications (including preoperative myocardial infarction, stroke, malignant arrhythmia, acute renal failure and respiratory insufficiency) of the two groups were compared between two groups. Results: The average EuroSCORE increased from 1.9 in 2007 to 5.7 in 2012; operation mortality decreased from 3.1% in 2007 to 2.3% in 2012. The average EuroSCORE was increasing year by year and the operation mortality declined slightly. The differences of the average EuroSCORE, operation mortality, ventilation time, and the incidence of complications between severe group and common group were statistically significant (p < 0.05). But the operation mortality of the two groups of was significantly lower than predicted mortality. Conclusion: When the operation indications continue to expand, the average EuroSCORE of the pa-tients in our hospital with heart valve disease increased year by year, operation mortality declined slightly. After the improvement of sufficient preoperative preparation, operation technology and strict preoperative care and treatment, the operation mortality of patients with severe
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