APACHEⅡ和SOFA评分对结肠穿孔手术风险的评估  

Evaluation of surgical risks in patients with colonic perforation by APACHEⅡ and SOFA score systems

作　　者：张维建[1] 韩少良[1] 蒋飞照[1] 俞志勇[2] 方瑶[1] 

机构地区：[1]温州医学院附属第一医院普外科,浙江温州325000 [2]浙江大学医学院附属第一医院外科,浙江杭州310031

出　　处：《外科理论与实践》2008年第3期197-200,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:评价联合应用APACHEⅡ和SOFA评分系统对结肠穿孔手术风险的预警作用。方法:回顾分析61例结肠穿孔病例,并比较其临床结果与评分系统的关系。结果:①本组一期手术病例平均APACHEⅡ评分(14.4±1.7)、平均SOFA评分(7.8±1.2)分别低于二期手术病例(19.5±2.6和9.3±1.9)(P<0.05);②APACHEⅡ评分≥18病例的死亡率(87.5%)显著高于评分<18者(29.7%)(P<0.01),尤其是>21病例的死亡率高达90.9%(20/22);③SOFA评分≥9病例的死亡率(80.0%)显著高于评分<9者(27.8%)(P<0.01),且19例SOFA评分≥11者全部死亡;④APACHEⅡ评分≥18且SOFA评分≥9病例的死亡率(94.7%)显著高于APACHEⅡ评分<18且SOFA评分<9者(68.6%)(P<0.01),APACHEⅡ评分>19且SOFA评分>11的病例全部死亡(17/17)。结论:APACHEⅡ和SOFA评分可较准确地评估结肠穿孔病人的手术风险和预后。Objective To evaluate the early prediction of operative risk in patients with colonic perforation by combined acute physiology and chronic health evaluation（APACHE Ⅱ ） score and by sepsis related organ failure assessment （SOFA） score. Methods Surgical risks in sixty-one patients with colonic perforation undergoing surgical treatment were analyzed retrospectively, and the relationship between the clinical results and the prediction by APACHE Ⅱand SOFA score systems was studied. Results In this study, （1）the median APACHE Ⅱ score（14.4±1.7） and median SOFA score （7.8±1.2） in stage Ⅰ operation patients were significantly lower than those （19.5±2.6 and 9.3±1.9） in stage Ⅱ operation patients （P〈0.05）; （2）the mortality （87.5%） in colonic perforation patients with APACHE Ⅱ score≥ 18 was significantly higher than that（29.7%） in those with APACHE Ⅱ score〈18（P〈0.01）; the mortality in patients with APACHE Ⅱ score〉21 was as high as 90.9%（20/22）; （3）the mortality（80.0%） in colonic perforation patients with SOFA score≥9 was significantly higher than that （27.8%） in those with SOFA score〈9 （P〈0.01）, and all 19 patients with SOFA score〉11 died; （4） the mortality（94.7%） in patients with APACHE Ⅱ≥ 18 and SOFA≥9 concomitantly, was significantly higher than that（68.6%） in patients with APACHE Ⅱ 〈18 and SOFA〈9 concomitantly （P〈0.01）. Furthermore, all 17 patients with APACHE Ⅱ 〉19 and SOFA〉11 concomitantly （P〈0.01） died. Conclusions The APACHE Ⅱand SOFA score systems help effectively to evaluate the surgical risk and prognosis in patients with colonic perforation.

关 键 词：APACHEⅡ评分 SOFA评分 结肠穿孔 死亡率 外科手术 

分 类 号：R656.9[医药卫生—外科学]