格拉斯哥动脉瘤评分作为腹主动脉瘤破裂手术后即刻预后的预测指标。

Glasgow Aneurysm Score as a predictor of immediate outcome after surgery for ruptured abdominal aortic aneurysm.

作者信息

Korhonen S J, Ylönen K, Biancari F, Heikkinen M, Salenius J-P, Lepäntalo M

机构信息

Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland.

出版信息

Br J Surg. 2004 Nov;91(11):1449-52. doi: 10.1002/bjs.4634.

DOI:10.1002/bjs.4634

PMID:15499653

Abstract

BACKGROUND

The aim of the study was to assess the value of the Glasgow Aneurysm Score in predicting postoperative death after repair of a ruptured abdominal aortic aneurysm (AAA).

METHODS

Between 1991 and 1999, 836 patients underwent surgery for ruptured AAA. Their operative risk at presentation was evaluated retrospectively using the Glasgow Aneurysm Score, based on data from the nationwide Finnvasc registry.

RESULTS

The operative mortality rate was 47.2 per cent (395 of 836); 164 patients (19.6 per cent) had cardiac complications and 164 (19.6 per cent) required intensive care treatment for more than 5 days. Predictors of postoperative death in univariate analysis were: coronary artery disease (P = 0.005), preoperative shock (P < 0.001), age (P < 0.001), and the Glasgow Aneurysm Score (P < 0.001). In multivariate analysis the predictors were: preoperative shock (odds ratio (OR) 2.13 (95 per cent confidence interval (c.i.) 1.45 to 3.11); P < 0.001) and the Glasgow Aneurysm Score (for an increase of ten units: OR 1.81 (95 per cent c.i. 1.54 to 2.12); P < 0.001). Receiver-operator characteristic (ROC) curves showed that the best cut-off value of the Glasgow Aneurysm Score in predicting postoperative death was 84 (area under the curve 0.75 (95 per cent c.i. 0.72 to 0.78), standard error 0.17; P < 0.001). The operative mortality rate was 28.2 per cent (114 of 404) in patients with a Glasgow Aneurysm Score of 84 or less, compared with 65.0 per cent (281 of 432) in those with a score greater than 84 (P < 0.001).

CONCLUSION

The Glasgow Aneurysm Score predicted postoperative death after repair of ruptured AAA in this series.

摘要

背景

本研究的目的是评估格拉斯哥动脉瘤评分在预测破裂腹主动脉瘤（AAA）修复术后死亡方面的价值。

方法

1991年至1999年间，836例患者接受了破裂AAA修复手术。根据全国Finnvasc登记处的数据，使用格拉斯哥动脉瘤评分对他们就诊时的手术风险进行回顾性评估。

结果

手术死亡率为47.2%（836例中的395例）；164例患者（19.6%）出现心脏并发症，164例（19.6%）需要重症监护治疗超过5天。单因素分析中术后死亡的预测因素为：冠状动脉疾病（P = 0.005）、术前休克（P < 0.001）、年龄（P < 0.001）和格拉斯哥动脉瘤评分（P < 0.001）。多因素分析中的预测因素为：术前休克（比值比（OR）2.13（95%置信区间（c.i.）1.45至3.11）；P < 0.001）和格拉斯哥动脉瘤评分（每增加10个单位：OR 1.81（95% c.i. 1.54至2.12）；P < 0.001）。受试者工作特征（ROC）曲线显示，格拉斯哥动脉瘤评分预测术后死亡的最佳临界值为84（曲线下面积0.75（95% c.i. 0.72至0.78），标准误0.17；P < 0.001）。格拉斯哥动脉瘤评分为小于或等于84分的患者手术死亡率为28.2%（404例中的114例），而评分大于84分的患者手术死亡率为65.0%（432例中的281例）（P < 0.001）。