60岁以上高龄患者急诊手术的风险评估  

Risk audit of elderly patients aged over 60 undergoing emergency operations

作　　者：刘斯[1] 赵建勋[2] 印建中[1] 陈旭岩[1] 刘玉村[2] 

机构地区：[1]北京大学第一医院急诊科,北京100034 [2]北京大学第一医院普通外科,北京100034

出　　处：《中国现代医学杂志》2012年第28期106-110,共5页China Journal of Modern Medicine

摘　　要：目的探讨美国麻醉医师协会分级(ASA分级)、手术风险评分(SRS)和生理及手术严重性(POS-SUM)评分系统对高龄患者急诊手术风险的评定意义。方法回顾性分析北京大学第一医院普通外科病房2009年1月～2010年12月行急诊手术且年龄在60岁以上(含60岁)共252例患者的临床资料。结果该组患者实际发生并发症和死亡分别为115例(45.60%)和7例(2.80%)。随着ASA分级及SRS评分的提高,手术后并发症率也升高(P=0.001,P=0.004)。POSSUM评分系统预测的术后并发症143例(56.70%),与实际相较差异无显著性(P=0.448),预测死亡36例(14.40%),存在明显高估(P<0.001)。P-POSSUM评分系统计算的术后死亡为12例(4.90%),SRS评分系统预测术后死亡16例(6.30%),均差异无显著性(P=0.242,P=0.055)。结论ASA分级、SRS评分及POSSUM评分系统可以较为准确地协助预测高龄患者的急诊手术风险,为外科决策提供参考依据。ASA分级使用简单,但目前缺乏根据ASA分级的风险定量计算公式,仅能对病人的手术风险进行粗略的定性评估。SRS评分综合考虑了患者基础情况和手术创伤因素,并可通过公式计算患者的预测死亡概率,提供了手术风险的量化指标。POSSUM评分更为全面、细致,但是信息收集和数据计算较为繁琐且需要收集手术资料甚至术后病理资料,在术前使用POSSUM评分预测术后风险的可靠程度受到影响。【Objective】 To evaluate the significance of American Society of Anesthesiologists（ASA） Physical Status Grading,Surgical Risk Score（SRS）,and Physiological and Operative Severity Score for the enumeration of Mortality（POSSUM） scoring system in prediction of the post-operative complication and the hospital mortality in the elderly patients undergoing emergency operations.【Methods】 Clinical data of 252 patients over 60 years-old underwent emergency operations during January 2009 to December 2010 were analyzed retrospectively.【Results】 The observed morbidity and mortality were 115（45.60%） and 7（2.80%）.As ASA grade and SRS score rising,post-operation complication rates were increased（P =0.001,P =0.004）.While POSSUM predicted 143（56.70%） post-operative complications（P =0.448） and 36（14.40%） post-operative deaths,which was over-predicted（P 0.001）.P-POSSUM predicted 12（4.90%） deaths,and SRS predicted 16（6.30%）,which were both able to predict mortality（P =0.001,P =0.004）.【Conclusion】 ASA grading,SRS and POSSUM score appeared to be useful tools for surgical risk audit of elderly patients undergoing emergency operations.ASA grading is easy to use,but there is no quantitative formula of risk assessment according to ASA grading.SRS,which is formulated,includes both of patient＇s underlying conditions and surgical trauma,and provides quantitative risk estimation.POSSUM scoring is more comprehensive,but needs complicated information collection and calculation.Preoperative risk assessment by POSSUM scoring is less reliable,because surgical and pathological data are needed,which are unavailable before surgery.

关 键 词：高龄患者 急诊手术 ASA分级 SRS评分 POSSUM评分系统 

分 类 号：R656.1[医药卫生—急诊医学] R619[医药卫生—外科学]