心脏手术风险预测方法的研究进展

手术风险预测是指用国际上权威的数学模型来预测患者术后不良事件的发生率、手术死亡率等。对于高风险的心脏外科手术，心脏手术风险预测可以指导制定治疗方案，规避术后并发症发生风险，已逐渐引起心脏外科医师的关注。心脏手术风险预测方法众多，包括欧洲心脏手术风险预测法（the European System for Cardiac Operative Risk Evaluation, EuroSCORE）、加拿大安大略省心脏手术风险预测法（Ontario Province Risk，OPR）、美国胸外科医师协会心脏手术风险预测法（the Society of Thoracic Surgeons score, STS score）、克利夫兰心脏手术风险预测法（Cleve，land model）、“质量测量和管理举措”心脏手术风险预测法（Quality Measurement and Management Initiative, QMMI）、美国心脏病学院／美国心脏协会心脏手术风险预测法（American College of Cardiology/American Heart Association,ACC/AHA Guidelines for Co;on-ary Art;ry Bypass Graft Surgery）以及中国冠状动脉旁路移植术风险预测法（Sino-System for Coronary Operative Risk Evaluation, SinoSCORE）等。它们都是根据某一地域内上千或上万例行心脏手术患者的数据而建立，由于数据来源存在地域性，不同预测方案的异质性，因此，当这些预测方法用来评价其他地域的病例时，往往会存在偏倚和异质性，如何避免偏差、提高预测效果是今后研究的主要目标。现对心脏手术风险预测方法的研究进展进行综述。

Research Progress of Risk Prediction Models for Patients Undergoing Cardiac Surgery

Surgical risk prediction is to predict postoperative morbidity and mortality with internationally authoritative mathematical models. For patients undergoing high-risk cardiac surgery, surgical risk prediction is helpful for decision-making on treatment strategies and minimization of postoperative complications, which has gradually arouse interest of cardiac surgeons. There are many risk prediction models for cardiac surgery in the world, including European System for Cardiac Operative Risk Evaluation （EuroSCORE）, Ontario Province Risk （OPR） score, Society of Thoracic Surgeons （STS） score, Cleveland Clinic risk score, Quality Measurement and Management Initiative （QMMI）, American College of Cardiology/American Heart Association （ACC/AHA） Guidelines for Coronary Artery Bypass Graft Surgery, and Sino System for Coronary Operative Risk Evaluation （SinoSCORE）. All these models are established from the database of thousands or ten thousands patients undergoing cardiac surgery in a specific region. As different sources of data and calculation imparities exist, there are probably bias and heterogeneities when the models are applied in other regions. How to decrease deviation and improve predicting effects had become the main research target in the future. This review focuses on the progress of risk prediction models for patients undergoing cardiac surgery.