CHADS2及CHA2DS2-VASc评分在冠心病外科治疗中的应用

目的：评价CHADS2及CHA2DS2-VASc评分系统在冠心病外科治疗中的意义。 方法：选择2006年1月至2010年1月行不停跳冠状动脉旁路移植术的768个病人，术后新发房颤患者97例，回顾病人的围术期及随访资料，应用CHADS2及CHA2DS2-VASc评分系统，进行分析。 结果：分为术后新发房颤组与非房颤组。术后新发房颤发生率12.6%。平均年龄70.74±8.21岁和65.90±9.83岁，围术期脑卒中8例和9例，CHADS2评分值分别为3.2±1.26和2.13±0.94，CHA2DS2-VASc评分值分别为4.2±1.50和3.23±1.07，CHADS2和CHA2DS2-VASc评分是术后新发房颤的预测因素，与围术期脑卒中显著相关，P < 0.01。 结论：冠心病外科治疗中应用CHADS2及CHA2DS2-VASc评分系统可预测术后新发房颤及围术期脑卒中，对冠心病术后新发房颤的抗凝及抗血小板治疗决策提供了依据，对卒中风险及预后有一定的评估价值。

The Application of CHADS2 and CHA2DS2-VASc Scoring in coronary artery bypass surgery

Background:The purpose of this study is to evaluate CHADS2 and CHA2DS2-VASc scoring in coronary artery bypass surgery. Methods:Clinical records of 768 patients who underwent off pump coronary artery bypass grafting surgery were analyzed retrospectively. CHADS2 and CHA2DS2-VASc scoring have been used in the analysis. Results: The patients were divided into two groups:postoperative atrial fibrillation group and non-atrial fibrillation group.The incidence of postoperative atrial fibrillation was 12.6%.The average age was 70.74±8.21 and 65.90±9.83 years old,the number of postoperative stroke was 8 and 9, CHADS2 score was 3.2±1.26 and2.13±0.94, CHA2DS2-VASc score was 4.2±1.50 and 3.23±1.07 respectively.CHADS2 and CHA2DS2-VASc scoring were predictors of postoperative atrial fibrillation and were closely associated with perioperaive stroke,P<0.01. Conclusion:Our results suggest that CHADS2 and CHA2DS2-VASc scoring are highly reliable in the prediction of postoperative atrial fibrillation as well as perioperative stroke.Therefore,the scoring system is valuable in anticoagulation and antiplatelet management and prophylactic consideration in coronary artery bypass surgery for atrial fibrillation and stroke.Hence, CHADS2 and CHA2DS2-VASc scoring system is applicable in clinical practice of coronary artery bypass surgery.