STS风险评估系统对单中心非体外循环冠状动脉旁路移植术后延长机械通气的预测价值分析

doi:10.3969/j.issn.1002-1949.2019.07.007

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摘要目的建立单中心非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting， OPCABG）后延长机械通气（prolonged mechanical ventilation， PMV）的风险预测模型，并与美国胸外科协会（Society of Thoracic Surgeons，STS）风险评估系统对比，评价两者对OPCABG患者术后PMV的预测效能。方法回顾性研究110例OPCABG患者的临床资料，分为未发生PMV组（机械通气时间≤24 h）与PMV组（机械通气时间＞24 h），通过单因素分析和二元Logistic逐步回归分析建立PMV风险预测模型。采用受试者工作特征曲线（receiver-operating characteristic, ROC）下面积（AUC）评估分辨力，Hosmer-Lemeshow（H-L）拟合优度检验、观察值（observed）∶期望值（expected）（O∶E值）评估校准度。结果全组PMV 28例，实际发生率25.45%。低身高（OR=0.932，95%CI0.876~0.991）、COPD（OR=18.894，95%CI 3.410~104.678）、术前心律失常（OR=4.645，95%CI1.430~15.086）是单纯OPCABG术后PMV的独立危险因素。PMV风险预测模型在全组分辨力良好（AUC=0.770＞0.75），高风险组分辨力可接受（AUC=0.733＞0.70），低风险组分辨力差（AUC=0.592＜0.70）；在全组（O∶E=0.999）、高风险组（O∶E=1.113）校准度良好，高估了低风险组（O∶E=0.734）PMV发生率。STS风险评估系统在全组分辨力可以接受（AUC=0.736＞0.70），校准度较差（O∶E=3.615），严重低估了全组的PMV发生率；低风险组（AUC=0.614＜0.70）、高风险组（AUC=0.567＜0.70）分辨力差，严重低估了两组的PMV发生率。结论 PMV风险预测模型可用于本中心全组、高风险组OPCABG患者术后PMV的预测，STS风险评估系统暂不适合用于本中心OPCABG患者术后PMV的风险评估。

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	王子玉
	傅强
	王树英
	张斌
	刘君玲
	孙贺元
	闫渭清

关键词 ：冠状动脉旁路移植术（CABG）, 延长机械通气（PMV）, 风险预测模型, 美国胸外科协会风险评估系统

基金资助:天津市卫生行业重点攻关项目（15KG121）

通讯作者: 傅强（1969-），男，博士，教授，博士生导师，主任医师，E-mail：13920864938@163.com。

作者简介: 王子玉（1990-），男，硕士研究生，E-mail：1044892292@qq.com。

引用本文:

王子玉，傅强，王树英，张斌，刘君玲，孙贺元，闫渭清. STS风险评估系统对单中心非体外循环冠状动脉旁路移植术后延长机械通气的预测价值分析[J]. 中国急救医学, 2019, 39(7): 642-648.
Wang Zi-yu, Fu Qiang, Wang Shu-ying, Zhang Bin, Liu Jun-ling, Sun He-yuan, Yan Wei-qing. Predictive value analysis of STS risk evaluation system for prolonged mechanical ventilation after off-pump coronary artery bypass grafting in single-center. Chinese Journal of Critical Care Medicine, 2019, 39(7): 642-648.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.07.007 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I7/642

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