一种新型术毕风险评分表:一项多中心回顾性研究  

A new postoperative risk scale:A multicenter retrospective study

作　　者：孙浩翔 龙思 吴建龙 殷爽 张耀贤[3] 张中军[3] 刘友坦 Sun Haoxiang;Long Si;Wu Jianlong;Yin Shuang;Zhang Yaoxian;Zhang Zhongjun;Liu Youtan(Department of Anesthesiology,Shenzhen Hospital of Southern Medical University,Shenzhen 518000,China;Department of Gastrointestinal Surgery,Peking University Shenzhen Hospital,Shenzhen 518000,China;Department of Anesthesiology,Shenzhen People's Hospital,2nd Clinical Medical College of Jinan University,Shenzhen 518000,China)

机构地区：[1]南方医科大学深圳医院麻醉科,518000 [2]北京大学深圳医院胃肠外科,518000 [3]暨南大学第二临床医学院,深圳市人民医院麻醉科,518000

出　　处：《国际麻醉学与复苏杂志》2021年第5期491-496,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(81670075)。

摘　　要：目的探讨研发一种新型术毕风险评分表用于危重患者术毕风险分级,为危重症患者术后是否入住ICU提供指导。方法回顾性分析3所大型三甲医院行腹部手术且术后入住ICU患者的临床资料。将患者分为A、B两组:A组为患者术后在ICU得到切实生命或器官功能支持和密切监护,有必要入住ICU;B组为患者术后在ICU没有得到生命或器官功能支持和密切监护,没必要入住ICU。使用自制术毕风险评分表对两组患者进行评分,统计得出两组患者术毕风险评分表评分及其95%CI。以患者术毕风险评分表评分≥A组95%CI下限作为术后入住ICU标准,≤B组95%CI下限作为术后回病房标准,统计两组患者处置错误率。以急性生理学和慢性健康状况评价Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)为对照评价术毕风险评分表评分,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价术毕风险评分表判断患者入住ICU或回病房的准确性。结果A组患者202例,B组患者322例。3所医院ICU患者术毕风险评分表评分差异无统计学意义(P>0.05)。B组患者术毕风险评分表评分为(16.87±4.02)分(95%CI 16.22~17.48分),A组患者术毕风险评分表评分为(24.57±6.23)分(95%CI 23.32~25.75分),两组患者术毕风险评分表评分差异有统计学意义(P<0.05)。A组患者的处置错误率为3%,B组患者处置错误率为6%。术毕风险评分表ROC曲线下面积为0.866(95%CI 0.818~0.914),敏感度为0.755,特异性为0.830。结论术毕风险评分表对于危重患者术后是否进入ICU有较好的预测和判断价值。评分≥23分强烈建议患者入住ICU,评分≤16分不建议进入ICU,分数为17~22分时建议入住PACU或结合患者其他临床情况由麻醉医师及手术医师共同商讨后续处置。Objective To explore and develop a new type of risk scale for assessment of critically ill patients at the end of operation,so as to provide guidance for admission in intensive care unit(ICU)after surgery.Methods Retrospective analysis was performed where clinical data were collected from patients who were admitted in three Grade-A-Tertiary hospitals for abdominal surgery before entry into ICU.The patients were divided into two groups:group A and group B.Patients in group A received organ function support and close monitoring in ICU after operation,and were considered necessary to stay in ICU.Those in group B did not receive organ function support or close monitoring in ICU,and were considered unnecessary to stay in ICU.A self-made postoperative risk scale was used to evaluate the patients,and their scores and 95%confidence interval(CI)were obtained.The postoperative risk score which was≥the lower limit of 95%CI in group A was set as the criteria for admission to ICU,while the postoperative risk score which was≤the lower limit of 95%CI in group B were set as the criteria for returning to the ward.The error rate of patients in group A and group B was calculated.Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)was used as a control to evaluate the postoperative risk score and the receiver operating characteristic(ROC)curve was plotted to evaluate the accuracy of the risk score in predicting admission to ICU or returning to ward.Results There were 202 patients in group A and 322 patients in group B.There was no significant difference in the risk scores among patients in the three hospitals(P>0.05).The risk score was 16.87±4.02(95%CI 16.22-17.48)for group B and 24.57±6.23(95%CI 23.32-25.75)for group A.There was significant difference in the risk scores between two groups(P<0.05).The error rate was 3%for group A and 6%for group B.The area under ROC curve was 0.866(95%CI 0.818-0.914),with a sensitivity of 0.755 and a specificity of 0.830.Conclusions The postoperative risk scale is useful to predict the

关 键 词：危重症 手术后 风险评估 重症监护治疗病房 

分 类 号：R656[医药卫生—外科学]