POSSUM及改良POSSUM在预测瓣膜置换术预后的应用  

Application of POSSUM and modified POSSUM in predicting prognosis after valve replacement

作　　者：韩超 李向群 黄大元[1] 唐亚兰 HAN Chao;LI Xiangqun;HUANG Dayuan;TANG Yalan(Medical College,Jishou University,Jishou,Hunan 416000,China;Department of Thoracic Surgery,Fourth Affiliated Hospital of Jishou University/First People′s Hospital of Huaihua City,Huaihua,Hunan 418000,China)

机构地区：[1]吉首大学医学院,湖南吉首416000 [2]吉首大学附属第四医院/怀化市第一人民医院心胸外科,湖南怀化418000

出　　处：《重庆医学》2019年第23期4039-4044,共6页Chongqing medicine

基　　金：2018湖南省研究生科研创新项目（CX2018B707）

摘　　要：目的 探讨生理学和手术严重度评分(POSSUM)及其改良评分系统(P-POSSUM)在预测瓣膜置换术并发症及死亡率的应用价值。方法 选取2017年1月1日至2018年12月31日在怀化市第一人民医院行心脏瓣膜置换手术患者132例,采用POSSUM及P-POSSUM对患者手术后并发症发生率、死亡率进行预测。比较实际值与预测值、死亡组与存活组在并发症、死亡率、生理评分(PS)及手术严重度评分(OS)的差异;绘制受试者工作特征(ROC)曲线并计算ROC曲线下面积(AUC),评价POSSUM及P-POSSUM的预测效能;采用二元Logistic回归模型分析治疗结果的影响因素。结果 132例患者实际愈合良好82例,术后发生并发症41例,死亡9例;POSSUM评分系统预测并发症25例、预测术后死亡82例,预测并发症发生率、死亡率与实际值比较,差异均有统计学意义(P<0.05);P-POSSUM预测术后死亡10例,预测死亡率与实际值比较,差异无统计学意义(P>0.05)。死亡组与存活组POSSUM预测并发症发生率、POSSUM预测死亡率及P-POSSUM预测死亡率有明显差异(P<0.05),两组PS、OS无明显差异(P>0.05)。P-POSSUM预测死亡率的AUC为0.654,以0.053为发生死亡的临界值,其灵敏度为0.778,特异度为0.520。Logistic回归分析显示,疾病结局严重程度的主要影响因素为年龄、血清钠水平。结论 POSSUM评分系统不适合预测瓣膜置换术后并发症,且明显高估了死亡率,而P-POSSUM评分系统预测死亡率具有一定的临床价值。Objective To explore the application value of physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM)and modified POSSUM(P-POSSUM)in predicting the complications and mortality after valve replacement.Methods A total of 132 cases of patients who underwent heart valve replacement from January 1,2017 to December 31,2018 in the First People′s Hospital of Huaihua City were selected for the study.The incidence of complications and mortality were predicted by using POSSUM and P-POSSUM.The actual and predicted values,the complications,mortality,physical score(PS)and surgical severity score(OS)between the death group and the survival group were compared.The receiver operating characteristic(ROC)curve was drawn,and the area under the ROC curve(AUC)was calculated to evaluate the predictive value of POSSUM and P-POSSUM.The binary logistic regression model was used to analyze the influencing factors of the treatment outcomes.Results Among 132 cases,82 cases healed well,41 cases had complications after operation,and 9 cases died.POSSUM scoring system predicted 25 cases of complications and 82 cases of death.There were statistically significant differences when compared the complication rate and mortality predicted by the POSSUM scoring system with the actual values(P<0.05).The P-POSSUM scoring system predicted 10 postoperative deaths.No statistically significant difference was found when compared the mortality predicted by the P-POSSUM scoring system with the actual value(P<0.05).The POSSUM predicted complication rate,POSSUM predicted mortality and P-POSSUM predicted mortality in the death group and the survival group were significantly different(P<0.05),and there was no significant difference in the PS and OS between the two groups(P>0.05).The AUC of P-POSSUM predicted mortality was 0.654,with 0.053 as the critical value for death,the sensitivity was 0.778,and the specificity was 0.520.Logistic regression analysis showed that the main influencing factors of disease severity were age

关 键 词：手术严重度评分 手术严重度改良评分系统 瓣膜置换术 手术后并发症 死亡率 

分 类 号：R654.2.[医药卫生—外科学]