骨科手术后肺栓塞风险评估量表的应用探讨  

Application of risk assessment scales in patients with pulmonary thromboembolism after orthopaedic surgery

作　　者：王晓芳[1] 刘春萍 张运剑[1] Wang Xiaofang;Liu Chunping;Zhang Yunjian(Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, Beij ing 100035, China)

机构地区：[1]北京积水潭医院呼吸与危重症医学科,100035 [2]陆军总医院心内科,北京100700

出　　处：《国际呼吸杂志》2018年第11期837-843,共7页International Journal of Respiration

基　　金：北京市科学技术委员会资助课题（Z141107002514153）

摘　　要：目的探讨简化改良版Geneva预后评分（sGPS）、肺栓塞严重度指数（PESI）及简化肺栓塞严重度指数（sPESI）对骨科手术后急性肺血栓栓塞症（PTE）患者危险分层的价值。方法采用回顾性病例-对照研究,将151例1997年1月至2016年12月北京积水潭医院确诊的骨科手术后急性PTE患者分为老年组（年龄≥65岁,n=77）和非老年组（年龄〈65岁,n=74）,对老年组和非老年组的人口学特征、手术方式、合并症、临床特征、sGPS、PESI、sPESI及30d病死率进行比较,并就sGPS、PESI、sPESI对30d病死率的预测价值进行分析。结果①老年组年龄（75.72±7.91）岁,非老年组年龄（48.82±1185）岁。老年组中接受髋部周围骨折手术、膝关节置换术、髋关节置换术患者比例较非老年组高（81.82%比25.68%,χ^2=26743,P〈0.05）。老年组动脉血氧饱和度〈90%的比例较非老年组高（6623%比4054%,χ^2=10.017,P〈0.05）。②根据sGPS、PESI、sPESI将老年及非老年患者分别分为低危和高危2个亚组。按照sGPS进行危险分层时,低危和高危亚组的比例在老年及非老年患者之间差异无统计学意义（P=0490）,而以PESI、sPESI危险分层时,老年患者更多地被划分为高危亚组,差异均有统计学意义（P值均〈0.05）。老年组30d病死率略高于非老年组（22.08%比16.22%）,但差异无统计学意义（χ^2=0.836,P=0.361）。无论老年还是非老年患者使用以上3种风险评估量表所划分的低危和高危亚组之间30d病死率差异均有统计学意义（P值均〈0.05）。③sGPS、PESI、sPESI预测老年组患者30d病死率的受试者工作特征曲线下面积分别为0.850、0.851、0.827,3种量表之间两两比较差异均无统计学意义（P值均〉0.05）,其中sPESI的敏感度及阴性预测值最高（均为1000%）;非老年组sGPS、PESI、sPESI的曲线下面积依次为0.858、0.959、0.905,其中PESI及sPESI的敏感度和阴性预测值均为100.0%。结�Objective To determine the prognostic value of simplified revised Geneva prognostic score （sGPS）, pulmonary embolism severity index （PESI） and simplified pulmonary embolism severity index （sPESI） in patients with acute pulmonary thromboembolism （PTE） after orthopaedic surgery. Methods A retrospective case-control study was carried out on 151 patients with identified acute PTE after orthopaedic surgery admitted to Beijing Jishuitan Hospital from January 1997 to December 2016. They were divided into the elderly group （≥65 years old, n = 77） and the non-elderly group （〈65 years old, n =74）. Their demographic characteristics, surgical methods, complications, clinical features, sGPS, PESI, sPESI and 30-day mortality were compared and analyzed. Results O In the elderly group, the patients were at age of （75.72± 7.91） years old. In the non-elderly group, the patients were at age of （48.82± 11.85） years old. Compared with the non-elderly group, more patients in elderly group received hip fracture surgery, total knee replacement and total hip replacement （81.82% vs 25.68%, χ^2=26. 743, P 〈0.05）. The decrease of arterial oxygen saturation in the elderly group was more common than that in the non-elderly group （66.23% vs 40.54%, χ^2=10.017, P 〈0.05）. ②The elderly group and nonelderly group were divided into low-risk subgroup and high-risk subgroup according to sGPS, PESI and sPESI,respectively. According to sGPS, the proportion of patients in the same subgroup between the elderly group and the non-elderly group was not significantly different （ P = 0. 490）. But compared with the non-elderly group, more patients in the elderly group were divided into high risk subgroup according to PESI and sPESI, the differences between the two groups were statistically significant （all P 〈0.05）. The 30-day mortality of the patients in the elderly group was slightly higher than that in the non-elderly group （22.08 % vs 16.22 %）, but the difference between the two groups was

关 键 词：肺栓塞 骨科手术 简化改良版Geneva预后评分 肺栓塞严重度指数 简化肺栓塞 严重度指数 

分 类 号：R563.5[医药卫生—呼吸系统] R687.3[医药卫生—内科学]