POSSUM及P-POSSUM对胃肠外科手术风险度的评价
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李丽 E-mail:LLLSD1@126.com

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An evaluation of POSSUM and P-POSSUM on surgical risk scoring in general surgery
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    摘要:

    目的:探讨术前使用POSSUM和P-POSSUM评分系统对预测胃肠外科患者术后并发症和病死率的准确性。
    方法:以POSSUM和P-POSSUM各项指标及常见临床影响因素为参考,对近1年内泸州医学院附属医院普外科收治的633例胃肠外科手术患者进行前瞻性的评估,并与患者实际并发症、死亡情况进行比较。以Logistic回归分析,非参数独立样本t检验,ROC曲线,预测和实际病死率及并发症符合度(OE比率)等统计学方法评价POSSUM及P-POSSUM预测的准确性。
    结果:POSSUM预测并发症发生数为229例,实际发生数为188例;P-POSSUM预测死亡数为44例,实际死亡数为34例,差异均无统计学意义(P>0.05);在高危机组(R1>38,R2>50)预测更具准确性,预测和实际病死率和并发症率符合度等于1;而在低危机组(R1<38,R2<50)则其死亡发生率被高估,预测和实际病死率和并发症率符合度大于1。多因素Logistic回归分析显示,肝功能、血糖、体高比、手术时间和术中血压的平稳因素与术后并发症和病死率均有相关性。
    结论:对于胃肠外科患者,POSSUM预测其并发症率和P-POSSUM预测其病死率有良好的相关性。

    Abstract:

    Objective:To stndy the correction in adopting pre-operative POSSUM and P-POSSUM for prediction of complications and mortality and  comparison with the actual postoperative complications and actual  mortality rates.
    Methods:POSSUM and P-POSSUM were used for prospective study in 633 cases undergoing G1 surgery in recent 1 year. With the various indicators, and clinical effects of common factors as reference, the POSSUM predicted complication rate and P-POSSUM predicted mortality rate were compared with the actual complication and mortality rate. Logistic regression analysis,non-parametric independent samples T test (Independent-Samples T Test), area under receiver operating characteristic curve, and prediction and the actual mortality (complications) in line with the degree of (OE ratio) evaluation of statistical methods were used to assess POSSUM and P-POSSUM prediction accuracy.
    Results:POSSUM predictiom in gastrointestinal surgery patients with complications was 229 cases, while the actual complications occured in 188 cases. P-POSSUM prediction of mortality was in 44 cases, while the actual deaths  occured in 34 cases;  in comparison there was no statistically significant difference (P>0.05). In high-risk group (R1>38, there was R2>50) more prediction accuracy and the actual mortality (complications) was in line with the degree of (OE ratio) equal 1, while in low-risk group  (R1<38、R2<50) it over-estimated mortality rate, and prediction and the actual mortality (complications) in line with the degree of  evaluation was greater than 1. Logistic regression analysis of many factors, liver function, blood glucose, body height ratio, operation time and intraoperative blood pressure stable etc. related with the postoperative complications and mortality.Conclusions:For gastrointestinal surgical patients, POSSUM prediction of their complication rate and P-POSSUM prediction of mortality have a good correlation.

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路忠志, 李丽, 杨宏伟, 吴斌, 李东生. POSSUM及P-POSSUM对胃肠外科手术风险度的评价[J].中国普通外科杂志,2010,19(4):409-413.
DOI:10.7659/j. issn.1005-6947.2010.04.020

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  • 收稿日期:2009-11-24
  • 最后修改日期:2010-03-13
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  • 在线发布日期: 2010-04-15