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Eur Heart J:心脏手术ACEF II风险评分!

2017-05-13 xing.T MedSci原创

由此可见,ACEF II 评分纳入了急症患者,再通过系数的再调整和纳入贫血指标,这样更加适合心脏手术患者。

年龄、肌酐、射血分数(ACEF)评分在2009被引入,目前被纳入欧洲心脏病学会和心胸外科协会的心肌血运重建指南作为外科手术和经皮心肌血管重建术的风险分层工具。近日,心血管领域权威杂志Eur Heart J上发表了一篇研究文章,研究人员介绍了ACEF的更新版本(ACEF II)包括急诊外科和术前贫血。

研究人员在开发队列中纳入同一机构的7011例连续的心脏手术患者,而在验证队列中纳入了不同机构的1687例连续的心脏手术患者。纳入ACEF II评分的五个因素采用多变量Logistic回归模型进行评估,以检验它们作为手术(住院或术后30天)死亡预测因子的独立作用。根据各指标的比值比,ACEF II评分计算了年龄(岁)/射血分数(%)。附加分包括血清肌酐>2 毫克/分升(2分)、急诊手术(3分)和贫血[红细胞压积(HCT)<36%,低于36%每一个HCT点记0.2分]。最终模型校准良好,ACEF II区分能力(C统计量为0.814)显著优于ACEF(C统计量0.773)(P=0.041),而与EuroSCORE II评分相当。在外部验证中,已经证实ACEF II 比ACEF要有更好的区分能力和良好的校准性能。

由此可见,ACEF II 评分纳入了急症患者,再通过系数的再调整和纳入贫血指标,这样更加适合心脏手术患者。

原始出处:

Marco Ranucci,et al. The ACEF II Risk Score for cardiac surgery: updated but still parsimonious. Eur Heart J. https://doi.org/10.1093/eurheartj/ehx228

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    2017-08-11 echonoir
  2. 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    2017-08-10 shanyongle
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    2017-12-04 echonoir
  4. 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encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon May 15 04:00:00 CST 2017, time=2017-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562526, encodeId=2af91562526d8, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon May 15 04:00:00 CST 2017, time=2017-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=198092, encodeId=8f48198092eb, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun May 14 20:59:06 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197884, encodeId=5cd619e884de, content=学习并分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun May 14 08:37:08 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197836, encodeId=0dea19e83681, content=心脏手术ACEF风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun May 14 07:25:14 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197795, encodeId=ed4e19e79555, content=文章很好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun May 14 06:50:16 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197614, encodeId=fd0c19e61424, content=好好,文章学习了。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-15 zhaojie88
  5. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun May 14 20:59:06 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197884, encodeId=5cd619e884de, content=学习并分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun May 14 08:37:08 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197836, encodeId=0dea19e83681, content=心脏手术ACEF风险。, beContent=null, objectType=article, channel=null, level=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-15 slcumt
  6. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-14 虈亣靌

    学习了,谢谢分享。

    0

  7. 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encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Mon May 15 04:00:00 CST 2017, time=2017-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562526, encodeId=2af91562526d8, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Mon May 15 04:00:00 CST 2017, time=2017-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=198092, encodeId=8f48198092eb, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, 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beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-14 大爰

    学习并分享!!!

    0

  8. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun May 14 20:59:06 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197884, encodeId=5cd619e884de, content=学习并分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun May 14 08:37:08 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197836, encodeId=0dea19e83681, content=心脏手术ACEF风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun May 14 07:25:14 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197795, encodeId=ed4e19e79555, content=文章很好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun May 14 06:50:16 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197614, encodeId=fd0c19e61424, content=好好,文章学习了。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-14 jyzxjiangqin

    心脏手术ACEF风险。

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1778933, encodeId=d94d1e7893331, content=<a href='/topic/show?id=13f41832a3' target=_blank style='color:#2F92EE;'>#ACEF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1832, encryptionId=13f41832a3, topicName=ACEF)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5ed3112, createdName=echonoir, createdTime=Fri Aug 11 12:00:00 CST 2017, time=2017-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1655764, encodeId=1eff1655e6439, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun May 14 20:59:06 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197884, encodeId=5cd619e884de, content=学习并分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun May 14 08:37:08 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197836, encodeId=0dea19e83681, content=心脏手术ACEF风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun May 14 07:25:14 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197795, encodeId=ed4e19e79555, content=文章很好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun May 14 06:50:16 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197614, encodeId=fd0c19e61424, content=好好,文章学习了。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-14 1e10c84am36(暂无匿称)

    文章很好,拜读了

    0

  10. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun May 14 20:59:06 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197884, encodeId=5cd619e884de, content=学习并分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun May 14 08:37:08 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197836, encodeId=0dea19e83681, content=心脏手术ACEF风险。, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun May 14 07:25:14 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197795, encodeId=ed4e19e79555, content=文章很好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun May 14 06:50:16 CST 2017, time=2017-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=197614, encodeId=fd0c19e61424, content=好好,文章学习了。。。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Neru1qt53a14aACuSzg3TZhkTcsPYVibyHibhTZ5L4k9qIBWiaej4lgomIsGptf8N16E4mTuIq2DVdJXjPjmwZKrLib/0, createdBy=5a0f2055853, createdName=135****7952平儿, createdTime=Sat May 13 15:52:08 CST 2017, time=2017-05-13, status=1, ipAttribution=)]
    2017-05-13 135****7952平儿

    好好,文章学习了。。。。。。。。

    0

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Anesthesiology:Presepsin(sCD14-ST)----心脏手术患者风险分级的新标志

麻醉疼痛科: Presepsin(sCD14-ST):心脏手术患者风险分级的新标志Presepsin(可溶性 CD14 亚型,sCD14-ST)是全身炎症反应综合征和败血症的风险分级的体液标记物。 为了研究presepsin能否作为选择性心脏手术患者风险分级的新标记物,作者以八百五十六名心脏手术患者为研究对象,将其术前血浆中这些标记物(preepsin,降钙素原,N-末端促尿钠肽,半胱氨酸蛋白酶抑

Br J Anaesth:心脏手术患者机械通气期间吸入性麻醉剂的功效和安全性评价

本项研究的目的是通过系统评价和荟萃分析评估挥发性麻醉剂对成人心脏手术患者术后镇静的疗效和安全性。

[ACC2017]LEVO-CTS:左西孟旦在心脏手术中的作用

华盛顿时间3月19日早8点,来自第66届ACC年会上发布的一项最新临床研究——LEVO-CTS表明,心脏手术时,心衰治疗药物左西孟旦作为一种预防措施,不显著降低死亡率、心脏病发作率、肾透析率以及低心输出量综合征高危患者的机械辅助装置使用率。该研究同期发表于《新英格兰医学杂志》。

NEJM:心脏手术后左西孟旦血流动力学支持疗效如何?

心脏手术后需要围手术期血流动力学支持的患者,低剂量的左西孟旦加上标准的治疗相比于安慰剂治疗并没有降低30天死亡率。

NEJM:左心室功能不全的接受心脏手术的患者接受左西孟旦治疗疗效如何?

在左室射血分数降低并接受体外循环心脏手术的患者中,预防性左西孟旦并未导致包含死亡、脏替代治疗、围手术期心肌梗死或使用机械心脏辅助装置的短期复合终点较安慰剂组要低。

Crit Care Med:心脏手术后心输出量的心率修正!

超声心动图引导的心率优化可以显著增加心脏输出,相比于术后的临床衍生的起搏设置。最佳心率应根据每个病人实现个体化,总的等容时间是灵敏度最高的超声心动图指标来确定最佳的血流动力学。

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