国际麻醉学与复苏杂志   2019, Issue (1): 0-0
    
病情-麻醉-手术三位一体方法与ASA-PS预测术中 心血管并发症风险比较
徐德朋, 江学成1()
1.解放军第九七医院
Predicting the risk of intraoperative cardiovascular complications with physical status-anesthesia-surgery method and American Society of Anesthesiologists Physical Status Classification
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摘要:

目的 建立病情-麻醉-手术三位一体预测术中心血管并发症风险的新方法。 方法 分别以美国麻醉学协会的患者体质分级标准(American Society of Anesthesiologists Physical Status Classification, ASA-PS)、Carrillo′s方法作为病情、手术、麻醉风险分级标准,制作风险评估量表。在2016年1月—2016年12月期间对3 543例各科手术患者进行术前风险评估和分级,记录术中心血管并发症。将病情-麻醉-手术的风险等级与术中心血管并发症进行二元逻辑分析,获得回归系数。利用Logistic回归方程,建立病情-麻醉-手术三位一体风险评估数学模型,用三位一体模型对术中心血管并发症进行预测并与直接用ASA?蛳PS建模的模型比较。 结果 3 543例患者术中共发生心血管并发症311例(8.78%)。三位一体方法中3种元素对术中并发症的贡献大小依次为病情、麻醉和手术元素,回归系数分别为0.886、0.508、0.268;ASA-S的回归系数为1.089。三位一体方法术中并发症预测公式为logit(P)=-6.298+0.886×ASA-PS等级+0.508×麻醉等级+0.268×手术等级;ASA-PS方法公式为logit(P)=-4.758+1.089×ASA-PS。三位一体方法的受试者工作特征曲线(receiver operating characteristic curve, ROC)和ROC 曲线下面积(area under the ROC curve, AUROC)为0.809,ASA-PS的AUROC为0.732。 结论 与ASA-PS比较,病情-麻醉-手术三位一体风险评估新方法预测术中心血管并发症的效力和拟合度较好。

关键词: 手术; 麻醉; 风险评估; 风险预测; 并发症; 美国麻醉学协会的患者体质分级
Abstract:

Objective To develop a new method to predict the risk of intraoperative cardiovascular complications. Methods American Society of Anesthesiologists Physical Status Classification(ASA-PS) and Carrillo′s risk classification were selected as the risk evaluation criteria for physical status, and anesthesia and surgery status, respectively. Preoperative risk assessment and grading were carried out in 3 543 surgical patients. The intraoperative cardiovascular complications were recorded. The risk of cardiovascular complications in patients with different classifications in the physical status, and anesthesia and surgery status were analyzed with Logistic analysis and the regression coefficients were obtained. The Logistic regression coefficient was used to establish a mathematical model, which was compared with ASA-PS model. Results Three hundred and eleven intraoperative cardiovascular complication (8.78%) occurred in 3 543 patients. According to the Logistic analysis, the risk of the complications include classifications of physical status, anesthesia and surgery elements with coefficients of 0.886,0.508 and 0.268, respectively, the coefficient of the ASA-PS was 1.089. The equation of the three-in-one model was logit(P) =-6.298+0.886×ASA-PS+0.508×anesthesia grade+0.268×surgical grade. The equation of the ASA-PS model is logit(P)=-4.758+1.089×ASA-PS. The area under the receiver operating characteristic curve(ROC) is 0.809 in the three-in-one model and is 0.732 in ASA-PS model. Conclusions The new method of physical status-anesthesia-surgery three-in-one risk assessment is better than ASA-PS model to predict intraoperative cardiovascular complications.

Key words: Surgery; Anesthesia; Risk assessment; Risk prediction; Complication; American Society of Anesthesiologists Physical Status Classification