ACEF评分、术前乳酸值及术前氧合指数在急性A型主动脉夹层中的研究进展

Research Progress on the ACEF Score, Preoperative Lactate Level, and Preoperative Oxygenation Index in Acute Type A Aortic Dissection

摘要: 急性A型主动脉夹层(acute type A aortic dissection, ATAAD)起病急骤、病情进展迅速、围术期死亡风险高，如何在入院后短时间内完成准确的术前风险分层，是优化救治流程和改善预后的关键环节。现有复杂评分工具虽具有一定预测能力，但在急诊场景下常受限于变量较多、计算繁琐及部分指标获取滞后。ACEF评分、术前乳酸水平及术前氧合指数(PaO₂/FiO₂)均具有获取快捷、临床可操作性强的特点，分别从基础生理储备、急性灌注与代谢应激状态以及肺功能储备/炎症易感性等不同维度反映ATAAD患者的围术期风险。本文结合近年来国内外相关研究，对上述3类指标在ATAAD患者术前风险评估中的研究进展进行综述，并就其优势、局限及联合应用前景进行总结。现有证据表明：ACEF评分可较稳定地预测ATAAD患者的住院死亡及中期不良结局；术前乳酸水平对识别灌注不足和高代谢应激状态具有较高敏感性，与死亡及严重并发症密切相关；术前氧合指数虽对死亡的直接预测证据相对有限，但与术后低氧血症、呼吸系统并发症及ICU不良结局密切相关。三者具有较强的互补性，有望为ATAAD患者建立更为简便、快速而多维的术前风险评估框架。

Abstract: Acute type A aortic dissection (ATAAD) is characterized by abrupt onset, rapid progression, and a high perioperative mortality risk. Timely and accurate preoperative risk stratification after admission is therefore crucial for optimizing rescue strategies and improving prognosis. Although several complex risk scores have shown predictive value, their use in emergency settings is often limited by numerous variables, cumbersome calculation, and delayed availability of some indicators. The ACEF score, preoperative lactate level, and preoperative oxygenation index (PaO₂/FiO₂) are readily available and clinically practical indicators. They reflect perioperative risk in ATAAD from different dimensions, including baseline physiological reserve, acute perfusion and metabolic stress, as well as pulmonary functional reserve and inflammatory susceptibility. This review summarizes recent domestic and international studies on the value of these three indicators in preoperative risk assessment for ATAAD, and further discusses their advantages, limitations, and potential for combined application. Current evidence suggests that the ACEF score can relatively stably predict in-hospital mortality and mid-term adverse outcomes; preoperative lactate is highly sensitive for identifying hypoperfusion and severe metabolic stress and is closely associated with mortality and major complications; and the preoperative oxygenation index, although supported by relatively limited direct evidence for mortality prediction, is strongly associated with postoperative hypoxemia, respiratory complications, and adverse ICU outcomes. These three indicators are complementary and may help establish a simpler, faster, and multidimensional framework for preoperative risk assessment in patients with ATAAD.