HIV感染者手术风险评分的设计与分析  

Design and analysis of surgical risk score for HIV-infected patients

作　　者：刘保池[1] 冯铁男[2] 李垒[1] 司炎辉[1] 陈晓栋[3] 王世佳[3] 

机构地区：[1]上海市公共卫生临床中心外科,201508 [2]同济大学医学院东方医院灾难医学系,上海200120 [3]中国科学院上海生命科学研究院健康所,200031

出　　处：《中华卫生应急电子杂志》2015年第5期28-31,共4页Chinese Journal of Hygiene Rescue(Electronic Edition)

摘　　要：目的设计HIV感染者手术风险评分表从而综合分析患者手术后脓毒症和病死率风险。方法对2009年1月至2014年12月在上海公共卫生临床中心外科收治的764例HIV感染手术患者的临床数据进行回顾性分析。根据患者是否发生脓毒症分为脓毒症组和非脓毒症组,用手术风险评估表检测2组的分值均数,检测评估表的敏感度和特异度。将CD4水平、手术切口分类、手术分级、机会性感染及器官功能这5项指标分别分为4个级别,分别赋予1~4分。结果术后256例发生脓毒症,发病率为34%(256/764)。术后30 d内死亡11例,均死于重度脓毒症,术后病死率为1.4%(11/764)。脓毒症组手术风险评分均值为11.62,非脓毒症组的手术风险评分均值为7.22。脓毒症组的平均评分值显著高于非脓毒症组。用评分表进行风险评估,在分隔阈值为9.5时,预测非脓毒症的敏感度为89.8%,特异度为95.1%。结论本文提出的手术风险评分表可以较准确地预测手术风险,帮助外科医师采取有效的预防措施。Objective To design surgical risk assessment system to systematically analyze the risk of developing post-operative sepsis and death of HIV-infected patients. Methods A retrospective study was conducted on clinical data of 764 HIV-infected patients admitted into Shanghai Public Health Clinical Center from January 2008 to December 2014. According the sepsis result,the patients were divided into two groups. The average score of the two groups were used to calculate the sensitivity and specificity value of the assessment system. Each of five indices including CD4 level,incision category,surgery grade,opportunistic infections and organ function were set for four grades,scoring from 1 to 4 points. Results Post-operative sepsis occurred in 256 patients,with morbidity of 34%( 256 /764). Eleven patients were died of serious sepsis in 30 days after surgery,with mortality of 1. 4%( 11 /764). The average score of surgery risk was 11. 62 in sepsis group while 7. 22 in non-sepsis group. The cutoff value was set 9. 5,when the sensitivity and specificity was 95. 1% and 89. 8%,respectively. Conclusion The assessment system proposed in this study can predict the surgery risk of HIV-infected patients and can help surgeons take effective countermeasures.

关 键 词：人类免疫缺陷病毒 手术后脓毒症 死亡率 风险评估系统 

分 类 号：R512.91[医药卫生—内科学]