Complete pulmonary vein ectopic drainage operation prognosis prediction scoring method

Abstract

The invention discloses a complete pulmonary vein ectopic drainage operation prognosis prediction scoring method. Comprising the following steps: S1, statistical analysis; s2, standard incorporation and exclusion; and S3, an ultrasonic parameter acquisition method. By generating an overall scoring standard, the probability of occurrence of poor prognosis of the complete pulmonary vein ectopic drainage operation can be comprehensively and scientifically predicted, the conditions that whether the operation is performed or not, which operation is specifically adopted and the like are predicted for patients and medical staff, and the success rate of the operation is increased; by analyzing the form and the inner diameter of the pulmonary vein common cavity, the overall development condition of the pulmonary vein of complete pulmonary vein ectopic drainage is evaluated, the prediction value for prognosis is very high, data support is provided for clinical decision making, the prediction accuracy is improved, the preoperative evaluation process is optimized, and scientific selection of a treatment scheme is assisted.

Description

Technical Field

[0001] The invention relates to the field of pulmonary venous drainage surgery detection, in particular to a prognosis prediction and scoring method for total anomalous pulmonary venous drainage surgery. Background Art

[0002] Total anomalous pulmonary venous connection is a complex cyanotic congenital heart malformation with complex classification and a wide spectrum of diseases. Clinical cyanosis symptoms are obvious and the disease progresses rapidly. Once diagnosed, it is an indication for surgery, so emergency surgical intervention is often required. At present, the success rate of total anomalous pulmonary venous connection surgery remains at a high level (more than 90%), but postoperative obstruction has become the main problem affecting long-term prognosis and the most important factor affecting the long-term survival rate of children after surgery. Domestic and foreign literature reports that the postoperative obstruction rate is as high as 10%-18%, and the effect of secondary surgery is not good.

[0003] A large number of studies have confirmed that multiple factors can affect postoperative obstruction. However, when confounding factors are combined, questions such as what the postoperative effect of the patient will be, whether surgery should be performed, and what type of surgery should be performed have always been difficult problems that have plagued medical staff and patients. Summary of the invention

[0004] The present invention is aimed at the technical defects mentioned in the background technology. First, it provides a scoring method for predicting the prognosis of total anomalous pulmonary venous connection surgery, and second, it provides a scoring system constructed based on the above scoring method. The present invention comprehensively collects the clinical indicators and imaging indicators of total anomalous pulmonary venous connection, assigns points to each indicator, and predicts the probability of poor surgical prognosis through scoring. Preoperative evaluation predicts the probability of postoperative obstruction, providing a scientific basis for preoperative clinical risk warning, accurate evaluation, reasonable treatment, improved prognosis and even prenatal consultation.

[0005] To achieve the above technical objectives, the technical solution adopted by the present invention is: a prognosis prediction scoring method for total anomalous pulmonary venous connection surgery, which specifically includes the following steps: S1 Statistical analysis S1-1: Collect case information, including clinical information and ultrasound effect data; S1-2: Draw the survival curve to obtain the overall postoperative good rate level; S1-3: The children were divided into event group and non-event group according to whether adverse events occurred after surgery. The clinical and ultrasound effects of the two groups of children were carefully statistically analyzed to obtain preliminary prediction indicators; S1-4: The COX proportional hazards model was used to determine the independent risk factors associated with poor surgical prognosis; the mixed type was finally determined to be an independent risk factor affecting prognosis; S1-5: Draw the ROC curve of the relevant indicators and the predictive efficacy of poor surgical prognosis according to the above statistical results, determine the final predictive indicators, and obtain the cut-off value; S1-6: Score the final included indicators according to the predictive efficacy of the ROC curve, and divide the risk stratification according to the total score; S2 Inclusion and exclusion criteria S2-1: Inclusion criteria All cases are complete total anomalous pulmonary venous connection cases diagnosed by surgery in our hospital; There are clear preoperative and postoperative echocardiogram data; There is a complete surgical record; Postoperative follow-up for more than 12 months; The informed consent form for this research content is signed by the guardians of the children; S2-2: Exclusion criteria Children undergoing secondary surgery; Children who cannot undergo biventricular correction, such as: functional single ventricle, situs inversus, atrial isomerism, etc.; Refusing surgical treatment; S3 Method for obtaining ultrasonic parameters Method for obtaining the anteroposterior inner diameter of the common pulmonary vein cavity: The common pulmonary vein cavity can be clearly shown behind the pulmonary artery and aorta at the high parasternal three-vessel section. Perpendicular to the anterior wall of the common pulmonary vein cavity, measure the anteroposterior inner diameter of the common pulmonary vein cavity.

[0006] As a preferred technical solution: In step S1-1, Clinical information includes name, gender, age in months, weight, surgical method, surgical circulation time, aortic cross-clamping time; Ultrasonic imaging data includes anatomical classification, whether there is drainage pathway obstruction before surgery, inner diameter of the common pulmonary vein cavity, and common pulmonary vein cavity index.

[0007] As a preferred technical solution: In step S1-3, the children are divided into an event group and a non-event group according to whether adverse events occur after surgery, and the clinical and ultrasonic imaging data of the two groups of children are statistically analyzed; Chi-square test or t-test is used to compare the gender, age, weight, Darling classification of complete total anomalous pulmonary venous connection, preoperative drainage pathway obstruction, surgical cardiopulmonary bypass time, aortic cross-clamping time, inner diameter of the common pulmonary vein cavity, and common pulmonary vein cavity index of the two groups of children; Finally, weight, Darling classification of complete total anomalous pulmonary venous connection, preoperative drainage pathway obstruction, surgical cardiopulmonary bypass time, aortic cross-clamping time, inner diameter of the common pulmonary vein cavity, and common pulmonary vein cavity index are selected as preliminary predictive indicators.

[0008] As a preferred technical solution: in step S1-5, after drawing the ROC curve, the factors with an area under the curve (AUC) > 0.65 are determined as the final prediction indicators of the model.

[0009] As a preferred technical solution: in step S1-6, according to the prediction efficiency of the ROC curve, scores are assigned to the final inclusion indicators, and the specific scoring method is as follows: (1) Anatomical classification: Supracardiac type: 1 point; Intracardiac type: draining into the coronary sinus: 1 point; draining into the right atrium: 2 points; Infracardiac type: 3 points; Mixed type: 4 points; (2) Preoperative obstruction of the drainage pathway: obstruction: 2 points; no obstruction: 0 points; (3) Cardiopulmonary bypass time: ≥100 min: 2 points; <100 min: 0 points; (4) Aortic cross-clamp time: ≥55 min: 2 points; <55 min: 0 points; (5) Diameter of the common pulmonary vein chamber: <6.35: 2 points; ≥6.35: 0 points; (6) Common pulmonary vein chamber index: <26.16: 2 points; ≥26.16: 0 points.

[0010] As a preferred technical solution: in step S1-6, the total score after scoring is used to divide the risk stratification; among them, 10-14 points are high risk; 5-9 points are medium risk; 1-4 points are low risk.

[0011] As a preferred technical solution: the calculation formula of the common pulmonary vein chamber index in step S3 is as follows: Common pulmonary vein chamber index = diameter of the common pulmonary vein chamber / body surface area.

[0012] As a preferred technical solution: in the calculation formula of the common pulmonary vein chamber index, the body surface area adopts the domestic children's health care formula:

[0013] As a preferred technical solution: a scoring system constructed based on the above-mentioned scoring method.

[0014] Compared with the prior art, the beneficial effects of the present invention are as follows: 1. By generating an overall scoring standard, it can comprehensively and scientifically predict the probability of adverse prognosis in the surgery of total anomalous pulmonary venous connection, and make predictions for patients and medical staff on whether to perform the surgery, which specific surgery to take with a greater certainty, etc., improving the success rate of the surgery; 2. By analyzing the morphology and inner diameter of the common pulmonary vein cavity, the overall development of the pulmonary veins in total anomalous pulmonary venous connection can be evaluated, which has great predictive value for prognosis, provides data support for clinical decision-making, improves prediction accuracy, optimizes the preoperative assessment process, and helps in scientifically selecting treatment plans. Description of the Drawings

[0015] Figure 1 This is the survival curve diagram in the present invention; Figure 2 This is the ROC curve diagram of the influence of cardiopulmonary bypass time on prognosis in the present invention; Figure 3 This is the ROC curve diagram of the influence of aortic cross-clamp time on prognosis in the present invention; Figure 4 This is the ROC curve diagram of the influence of the inner diameter of the common pulmonary vein cavity on prognosis in the present invention; Figure 5 This is the ROC curve diagram of the influence of the common pulmonary vein cavity index on prognosis in the present invention; Figure 6 This is the ROC curve diagram of the influence of preoperative obstruction on prognosis in the present invention; Figure 7 This is the schematic diagram of the ultrasonic measurement section of the common pulmonary vein cavity in the present invention. Detailed Embodiment

[0016] The present invention will be further described below in conjunction with the drawings and embodiments.

[0017] This prediction scoring method disclosed by the present invention can comprehensively and scientifically predict the probability of poor prognosis in total anomalous pulmonary venous connection surgery by generating an overall score. It will predict the probability of postoperative obstruction during preoperative assessment, and provide a scientific basis for preoperative clinical risk warning, accurate assessment, reasonable disposal, improving prognosis, and even prenatal consultation.

[0018] This prognosis prediction scoring method for total anomalous pulmonary venous connection surgery specifically includes the following steps.

[0019] S1 Statistical Analysis S1-1: Collect case information, including clinical information and ultrasonic imaging data; Clinical information includes name, gender, age in months, weight, surgical method, surgical circulation time, aortic cross-clamp time; Ultrasonic imaging data includes anatomical classification, whether there is obstruction in the drainage pathway before surgery, inner diameter of the common pulmonary vein cavity, common pulmonary vein cavity index.

[0020] S1-2: Draw the Kaplan-Meier survival curve, as shown in Figure 1 , and obtain the overall postoperative good rate level.

[0021] S1-3: The children were divided into an event group and a non-event group according to whether adverse events occurred after the operation. The clinical and ultrasonic effects of the two groups of children were statistically analyzed to obtain preliminary prediction indicators. The children were divided into an event group and a non-event group according to whether adverse events occurred after the operation. The clinical and ultrasonic imaging data of the two groups of children were statistically analyzed; chi-square test or t-test was applied. Considering the normal distribution of continuous variables, categorical variables were expressed in the form of n (%). The between-group differences were compared using the chi-square test or Fisher's exact test. For continuous variables, if the data conform to the normal distribution, they were expressed as mean ± standard deviation, and the independent sample t-test was used for between-group comparison; if the data do not conform to the normal distribution, they were expressed as median (Q1, Q3), and the Wilcoxon rank sum test was used for between-group differences.

[0022] The gender, age, weight, Darling classification of total anomalous pulmonary venous connection, preoperative obstruction of the drainage pathway, cardiopulmonary bypass time, aortic cross-clamping time, common pulmonary vein cavity diameter, and common pulmonary vein cavity index of the two groups of children were compared; finally, weight, Darling classification of total anomalous pulmonary venous connection, preoperative obstruction of the drainage pathway, cardiopulmonary bypass time, aortic cross-clamping time, common pulmonary vein cavity diameter, and common pulmonary vein cavity index were selected as preliminary prediction indicators.

[0023] S1-4: The COX proportional hazards model was used to determine the independent risk factors associated with poor surgical prognosis; finally, the mixed type was determined as the independent risk factor affecting the prognosis.

[0024] In this embodiment, the risk odds ratio is 3.84.

[0025] S1-5: According to the above statistical results, an ROC curve of the correlation between the relevant indicators and the prediction efficacy of poor surgical prognosis was drawn, as shown in Figures 2 - 6 , and the final prediction indicators were determined, and the cut-off value was obtained; after drawing the ROC curve, the factors with the area under the curve AUC > 0.65 were determined as the final prediction indicators of the model.

[0026] The inclusion indicators were gender, age in months, weight, surgical method, cardiopulmonary bypass time, aortic cross-clamping time, anatomical classification, whether there was obstruction of the drainage pathway before surgery, common pulmonary vein cavity diameter, and common pulmonary vein cavity index.

[0027] Finally, it was determined that six indicators, namely cardiopulmonary bypass time, aortic cross-clamping time, anatomical classification, whether there was obstruction of the drainage pathway before surgery, common pulmonary vein cavity diameter, and common pulmonary vein cavity index, were statistically significant. Among them, the prediction efficacy of the anatomical classification group could not be represented by the ROC curve.

[0028] S1-6: Score the final inclusion criteria according to the prediction efficacy of the ROC curve, and divide the risk stratification according to the total score; score the final inclusion criteria according to the prediction efficacy of the ROC curve. A total of 6 factors are finally obtained. Among them, a mixed type is obtained by COX regression, and the efficacy of the remaining 5 factors is evaluated by the ROC curve. Finally, the scores are assigned together.

[0029] The specific scoring method is as follows:

[0030] Specifically, first, through chi-square test and t-test, determine that the factors with statistical differences between the two groups are risk factors, and determine the scores according to the ROC curve efficacy. However, there are four types of classifications. The chi-square test can only show that the classification factor has an impact, but it does not know which type of classification is good and which is bad. The ROC method cannot be used, so further COX regression is required. COX shows that the mixed type is an independent risk factor, and the mixed type should be scored more. The specific steps are to group first, and then perform chi-square and t-tests to determine seven factors; the seven factors are divided into two types: six of them use ROC, and one uses COX; ROC excludes one (weight AUC = 0.61), and COX determines one type with the worst prognosis (mixed type).

[0031] Divide the risk stratification according to the total score after scoring; among them, 10-14 points are high risk; 5-9 points are medium risk; 1-4 points are low risk.

[0032] S2 Inclusion and exclusion criteria S2-1: Inclusion criteria (1) All cases are complete total anomalous pulmonary venous connection cases diagnosed by surgery in our hospital; (2) Have clear preoperative and postoperative echocardiogram data; (3) Have complete surgical records; (4) Postoperative follow-up for more than 12 months; (5) The informed consent form for this research content is signed by the guardians of the children; S2-2: Exclusion criteria (1) Children undergoing secondary surgery; (2) Children who cannot undergo biventricular repair, such as: functional single ventricle, situs inversus, atrial isomerism, etc.; (3) Refusing surgical treatment; S3 Method for obtaining ultrasonic parameters Method for obtaining the anteroposterior inner diameter of the common pulmonary vein cavity: The common pulmonary vein cavity behind the pulmonary artery and aorta can be clearly shown in the high parasternal three-vessel section. Perpendicular to the anterior wall of the common pulmonary vein cavity, measure the anteroposterior inner diameter of the common pulmonary vein cavity.

[0033] The calculation formula for the common pulmonary vein cavity index is as follows: Common pulmonary vein cavity index = Inner diameter of the common pulmonary vein / Body surface area.

[0034] The body surface area is calculated using the domestic children's health care medical formula:

Claims

1. A scoring method for predicting the prognosis of total anomalous pulmonary venous connection surgery, characterized in that: The specific steps include: S1 Statistical analysis S1-1: Collect case information, including clinical information and ultrasound effect data; S1-2: Draw the survival curve to obtain the overall postoperative good rate level; S1-3: The children were divided into event group and non-event group according to whether adverse events occurred after surgery. The clinical and ultrasound effects of the two groups of children were carefully statistically analyzed to obtain preliminary prediction indicators; S1-4: The COX proportional hazards model was used to determine the independent risk factors associated with poor surgical prognosis; the mixed type was finally determined to be an independent risk factor affecting prognosis; S1-5: Based on the above statistical results, draw the ROC curve of the relevant indicators and the predictive efficacy of poor surgical prognosis, determine it as the final prediction indicator, and obtain the cutoff value; S1-6: According to the predictive efficiency of the ROC curve, the final entry index is scored and the risk stratification is divided according to the total score; S2 Inclusion and Exclusion Criteria S2-1: Inclusion criteria All cases were total anomalous pulmonary venous connection cases diagnosed surgically in our hospital; Have clear preoperative and postoperative echocardiographic data; Have complete surgical records; Postoperative follow-up was more than 12 months; The guardian of the child signed an informed consent form for the content of this study; S2-2: Exclusion criteria Children undergoing secondary surgery; Children who cannot undergo biventricular correction, such as those with functional single ventricle, situs inversus, atrial isomerism, etc. Refuse surgical treatment; S3 Ultrasonic Parameter Acquisition Method Method for obtaining the anterior-posterior internal diameter of the common pulmonary vein cavity: The high parasternal three-vessel section can clearly show the common pulmonary vein cavity behind the pulmonary artery and aorta. The anterior-posterior internal diameter of the common pulmonary vein cavity is measured perpendicular to the anterior wall of the common pulmonary vein cavity.

2. The method for predicting the prognosis of total anomalous pulmonary venous connection surgery according to claim 1, characterized in that: In step S1-1, Clinical information included name, sex, age in months, weight, surgical method, surgical cycle time, and aortic clamping time; Ultrasound imaging data included anatomical classification, presence of drainage obstruction before surgery, pulmonary vein common lumen diameter, and pulmonary vein common lumen index.

3. The prognosis prediction scoring method for total anomalous pulmonary venous connection surgery according to claim 1, characterized in that: In step S1-3, the children were divided into an event group and a non-event group according to whether adverse events occurred after the operation, and the clinical and ultrasound imaging data of the two groups of children were statistically analyzed; the chi-square test or t-test was used to compare the gender, age, weight, Darling classification of total anomalous pulmonary venous connection, preoperative drainage pathway obstruction, surgical extracorporeal circulation time, aortic occlusion time, pulmonary vein common lumen diameter, and pulmonary vein common lumen index of the two groups of children; finally, weight, Darling classification of total anomalous pulmonary venous connection, preoperative drainage pathway obstruction, surgical extracorporeal circulation time, aortic occlusion time, pulmonary vein common lumen diameter, and pulmonary vein common lumen index were selected as preliminary prediction indicators.

4. The method for predicting the prognosis of total anomalous pulmonary venous connection surgery according to claim 1, characterized in that: In step S1-5, after the ROC curve is drawn, the factors with area under the curve AUC>0.65 are determined as the final prediction indicators of the model.

5. The method for predicting the prognosis of total anomalous pulmonary venous connection surgery according to claim 1, characterized in that: In step S1-6, the final entry index is scored according to the prediction efficiency of the ROC curve. The specific scoring method is as follows: (1) Anatomical classification: 1 point for heart-shaped type; Intracardiac drainage to the coronary sinus 1 point; drainage to the right atrium 2 points; 3 points for subcardiac type; Mixed: 4 points; (2) Obstruction of drainage pathway before surgery: 2 points for obstruction; 0 points for no obstruction; (3) Extracorporeal circulation time: ≥100 min, 2 points; <100 min, 0 points; (4) Aortic occlusion time: ≥55 min, 2 points; <55 min, 0 points; (5) Pulmonary vein common lumen diameter: <6.35, 2 points; ≥6.35, 0 points; (6) Pulmonary vein common cavity index: <26.16, 2 points; ≥26.16, 0 points.

6. The method for predicting the prognosis of total anomalous pulmonary venous connection surgery according to claim 1, characterized in that: In step S1-6, the total score after assignment is divided into risk stratification; 10-14 points are high risk; 5-9 points are medium risk; 1-4 points are low risk.

7. The prognosis prediction scoring method for total anomalous pulmonary venous connection surgery according to claim 1, characterized in that: The calculation formula of the pulmonary vein common cavity index in step S3 is as follows: Pulmonary vein common lumen index = pulmonary vein common lumen diameter / body surface area.

8. The method for predicting the prognosis of total anomalous pulmonary venous connection surgery according to claim 7, characterized in that: In the calculation formula of the pulmonary vein common cavity index, the body surface area adopts the domestic children's health care formula:

9. A scoring system constructed based on the scoring method according to any one of claims 1 to 8.

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