在心脏切除术后的患者中对修改的SCAISHOCK分类进行序列评估

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B U Baldan¹, M C van de Veerdonk², P R Tuinman³

¹Department of Cardiothoracic surgery, part of the Institute of Heart and Lung Surgery Netherlands, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Amsterdam, the Netherlands; Department of Cardiothoracic surgery, part of the Institute of Heart and Lung Surgery Netherlands, Leiden University Medical Center, University of Leiden, Leiden, the Netherlands.

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概括

心血管血管血管学和干预系列协会 (SCAI) SHOCK分期准确预测心脏切除术后休克 (PCS) 患者的住院死亡率. 在七天内重复评估可以提高预后价值,超越初始阶段,以获得更好的结果.

科学领域:

心脏病学心脏病学
临界护理医学临界护理医学
医疗保健服务研究医疗服务研究

背景情况:

心脏切除术后的休克 (PCS) 是心脏手术后的一个关键并发症,与高死亡率有关.
心血管血管图谱和干预学会 (SCAI) 的SHOCK分类用于初始冲击阶段.
在PCS患者中,连续SCAI SHOCK重新分类的预后准确性需要进一步验证.

研究的目的:

为了外部验证串行SCAI SHOCK重新分类的预后值和准确性.
评估从手术后第一天到第七天PCS患者的全因住院死亡率.
为了确定序列分期是否与初始分期相比改善死亡率预测.

主要方法:

这是一项回顾性,观察性,多中心的研究,涉及9,258名心脏切除术后的成年患者.
每日SCAI SHOCK分期从术后第一天到第七天.
用歧视 (AUC) 和校准分析所有原因的住院死亡率.

主要成果:

在第一天,38%的患者处于休克状态 (C-E阶段);到第三天,91%的患者被重新分类为没有休克状态 (A-B阶段).
住院死亡率随着更高的休克阶段和更长的休克持续时间而增加.
SCAI SHOCK分类表现出强烈的歧视 (AUC 0.82-0.85) 和每天改进的校准.

结论:

序列SCAI SHOCK分类准确预测PCS患者的住院死亡率.
重复评估比初始分期提供了更好的预后价值.
长时间的休克持续时间与死亡率的增加有关.

关键词:

这是一个巨大的天空.在SCAI SHOCK分类中,心脏外科手术的心脏手术心脏切除术后的休克冲击.

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