CAJ | 학술논문

目的建立预测A型主动脉夹层孙氏手术后重症监护病房(ICU)停留时间延长的评分系统,初步探索预测主动脉手术风险评估系统的数学模型.方法 2009年2月至2012年2月,连续384例A型主动脉夹层行孙氏手术患者纳入研究.ICU时间延长定义为ICU停留时间超过7天.将ICU时间延长的可能危险因素纳入单因素分析,单因素分析有意义的变量纳入多因素logistic回归分析,建立预测孙氏手术后ICU时间延长的数学预测模型.模型的区分能力采用受试者工作特征曲线评估,校正能力采用Hosmer-Lemeshow拟合优度检验.结果院内死亡31例,占8.07％.ICU停留时间平均3.06天.42例超过7天.Logistic回归结果显示,卒中病史(P=0.001,OR=9.40,回归系数=2.24)、肌酐清除率≤50 ml/min(P=0.03,OR =2.91,回归系数=1.07)、发病至手术时间小于1周(P =0.003,OR=2.89,回归系数=1.06)和术中同时行冠状动脉旁路移植术(P=0.03,OR=3.14,回归系数=1.15)有统计学意义.定义logistic简易评分:卒中病史22分,肌酐清除率≤50 ml/min 11分,发病至手术时间小于1周11分,术中行冠状动脉旁路移植术12分.Additive评分:卒中病史9分,肌酐清除率≤50 ml/min 3分,发病至手术时间小于1周3分,术中行冠状动脉旁路移植术3分.Logistic简易评分的受试者工作特征曲线下面积为0.72,校正能力Hosmer-Lemeshow拟合优度检验满意(P＞0.05).Additive评分的受试者工作特征曲线下面积为0.71,校正能力Hosmer-Lemeshow拟合优度检验欠佳(P＜0.05).结论利用logistic回归模型建立预测主动脉手术预后的风险评估系统可行,根据回归系数建立简化logistic评分能够简化模型,在保证准确性的同时又便于临床使用.Additive模型的方法准确性不够,应放弃.
목적 건립예측A형주동맥협층손씨수술후중증감호병방(ICU)정류시간연장적평분계통,초보탐색예측주동맥수술풍험평고계통적수학모형.방법 2009년2월지2012년2월,련속384례A형주동맥협층행손씨수술환자납입연구.ICU시간연장정의위ICU정류시간초과7천.장ICU시간연장적가능위험인소납입단인소분석,단인소분석유의의적변량납입다인소logistic회귀분석,건립예측손씨수술후ICU시간연장적수학예측모형.모형적구분능력채용수시자공작특정곡선평고,교정능력채용Hosmer-Lemeshow의합우도검험.결과 원내사망31례,점8.07％.ICU정류시간평균3.06천.42례초과7천.Logistic회귀결과현시,졸중병사(P=0.001,OR=9.40,회귀계수=2.24)、기항청제솔≤50 ml/min(P=0.03,OR =2.91,회귀계수=1.07)、발병지수술시간소우1주(P =0.003,OR=2.89,회귀계수=1.06)화술중동시행관상동맥방로이식술(P=0.03,OR=3.14,회귀계수=1.15)유통계학의의.정의logistic간역평분:졸중병사22분,기항청제솔≤50 ml/min 11분,발병지수술시간소우1주11분,술중행관상동맥방로이식술12분.Additive평분:졸중병사9분,기항청제솔≤50 ml/min 3분,발병지수술시간소우1주3분,술중행관상동맥방로이식술3분.Logistic간역평분적수시자공작특정곡선하면적위0.72,교정능력Hosmer-Lemeshow의합우도검험만의(P＞0.05).Additive평분적수시자공작특정곡선하면적위0.71,교정능력Hosmer-Lemeshow의합우도검험흠가(P＜0.05).결론 이용logistic회귀모형건립예측주동맥수술예후적풍험평고계통가행,근거회귀계수건립간화logistic평분능구간화모형,재보증준학성적동시우편우림상사용.Additive모형적방법준학성불구,응방기.
Objective To establish the risk scoring system in predicting prolonged intensive care unit(ICU) stay after Sun' s procedure(total aortic arch replacement with stented elephant trunk implantation) for Stanford type A aortic dissection.Accumulate experience in establishing the mathematical model in predicting the prognosis of Chinese people undergoing aortic surgery.Methods Between February 2009 and February 2012,data from 384 consecutive patients in Bejing Anzhen Hospotal,who underwent aortic surgery using Sun' s procedure,were collected retrospectively.Lengths of ICU stay longer than 7 days was defined as prolonged ICU stay.All the factors related to prolonged ICU stay were entered into univariate analysis.Then the variables with statistical difference were entered into multiple logistic analysis.The mathematical model was established based on the logistic analysis.The C-statistic was used to test discrimination of the model.Calibration was assessed with the Hosmer-Lemeshow goodness-of-fit statistic.Results The in-hospital mortality was 8.07％.The mean length of ICU stay was 3.06 days.42 patients stayed in ICU for 7 days or more.Logistic regression identified that preoperative stroke history(P =0.001,0R =9.40,regression coefficient =2.24),creatinine clearance ≤ 50 ml/min (P =0.03,OR =2.91,regression coefficient =1.07) surgical period from symptom onset shorter than 1 week (P =0.003,OR =2.89,regression coefficient =1.06),combining with coronary artery bypass grafting(P =0.03,OR =3.14,regression coefficient =1.15) were final independent risk factor for prolonged ICU stay.Simple logistic score were defined as:stroke history 22 points,creatinine clearance ≤50 ml/min 11 points,surgical period from symptom onset shorter than 1 week 11 points,combining with coronary artery bypass grafting 12 points.Additive score was defined as:stroke history 9 points,surgical period from symptom onset shorter than 1 week 3 points,creatinine clearance≤50 ml/min 11 points 3 points,combining with coronary artery bypass grafting 3 points.C statistic (receiver operating characteristic curve) for logistic algorithm was 0.72 and for additive model was 0.71.However,Hosmer Lemeshow goodness-of-fit was good (P ＞ 0.05) for logistic algorithm,was poor for additive model(P ＜ 0.05).Conclusion Using logistic regression to establish a scoring system predicting the prognosis of aortic surgery is feasible.The predicting model utilizing regression coefficient is accurate and is convenient for clinical using.Additive algorithm is not accurate and should be abandoned.