POSSUM评分预测胸外科高龄患者术后并发症发生率和死亡率的价值  

Estimation of mortaliy and morbidity risk in aged patients undergoing thoracic surgery using POSSUM

作　　者：杨立伟[1] 白世祥[1] 孟宪利[1] 何明[1] 刘庆熠[1] 陈新[1] 

机构地区：[1]河北医科大学第四医院胸心外科,石家庄050011

出　　处：《解放军医学杂志》2006年第2期150-151,共2页Medical Journal of Chinese People's Liberation Army

基　　金：河北省卫生厅科技攻关课题(04153)

摘　　要：目的探讨POSSUM评分预测胸外科高龄患者术后并发症发生率和死亡率的价值。方法对206例胸外科高龄患者进行POSSUM评分,用胸腔污染代替腹腔污染,预测术后并发症和死亡例数,并与实际值进行比较。结果共有97例患者术后发生并发症,并发症组生理学评分、手术侵袭度评分均明显高于无并发症组(生理学评分,19·3±0·7vs15·1±0·6,P<0·01;手术侵袭度评分,15·9±0·2vs14·8±0·4,P<0·01)。POSSUM评分预测术后并发症人数为90例,实际并发症人数为97例,差异无显著性(P=0·972);POSSUM评分预测术后死亡人数为16例,实际死亡人数为5例,差异有显著性(P=0·022)。结论POSSUM评分能较好地预测胸外科高龄患者术后并发症,但对术后死亡存在过度预测。Objective To evaluate the clinical validity of physiological and operative severity score for the enumeration of mortality and morbidity （POSSUM） in aged patients undergoing thoracic surgery. Methods Physiological and operative severity scores were kept in 206 aged patients undergoing thoracic surgery, in which peritoneal soiling was converted to pleura soiling. The physiological score and the operative risk score were compared between the groups with or without the postoperative complications. The mortality and morbidity rates were calculated. Actual mortality and morbidity rates were compared with the rates predicted by POSSUM. Results Among 206 patients, there were postoperative complications in 97 patients. The physiological score and the operative severity score were significantly higher in the group in whom complications occurred compared with those without complications （19.3±0. 7 vs 15. 1±0. 6 for physiological score, P〈 0. 01 ; 15. 9±0. 2 vs 14.8±0. 4 for operative severity score, P〈0. 01）. The morbidity rate predicted by POSSUM was （90/206） and the actual morbidity rate was （97/206）. There was no significant difference （P=0. 972）. The mortality rate estimated by POSSUM was （16/ 206）, which was significantly different from the actual rate （5/206） （P=0. 022）. Conclusion The POSSUM gave satisfactory prediction of morbidity rate but overrated the prediction of mortality rate in aged patients undergoing thoracic surgery.

关 键 词：胸外科手术 生理学和手术严重性评分 手术后并发症 老年人 

分 类 号：R655[医药卫生—外科学]