CAJ | 학술논문

目的探讨改良急性生理和慢性健康状态评价系统Ⅱ(APACHE-Ⅱ)对结直肠癌并急性肠梗阻患者术后并发症的预测价值.方法回顾性分析92例结直肠癌并急性肠梗阻患者术后并发症情况,对传统APACHE-Ⅱ评分和改良APACHE-Ⅱ评分系统(将慢性健康指标中的严重器官功能不全或免疫损害改为梗阻时间和梗阻程度,并以此两项作为肠梗阻侵袭度)预测术后并发症的敏感度、特异度、准确性及约登指数进行比较,并通过绘制受试者工作特征曲线(ROC)来计算曲线下面积(AUC).结果 92例患者术后有25例出现并发症(包括3例围手术期死亡病例),并发症组APACHE-Ⅱ评分(13.72±4.24)、改良APACHE-Ⅱ评分(19.28±4.92)及肠梗阻侵袭度评分(5.56±2.20)均显著高于无并发症组(10.58±3.44、14.69±3.73和4.10±1.52,均P＜0.01).改良APACHE-Ⅱ评分取最佳截点(20分),其预测术后并发症的敏感度、特异度、准确性、约登指数及AUC分别为0.640、0.940、0.859、0.580和0.839,均高于传统APACHE-Ⅱ评分(以14分为最佳截点),其上述指标分别为0.560、0.896、0.804、0.456和0.784.结论将APACHE-Ⅱ评分系统增加肠梗阻侵袭度这一指标后,能更好地预测结直肠癌并急性肠梗阻患者的术后并发症.
목적 탐토개량급성생리화만성건강상태평개계통Ⅱ(APACHE-Ⅱ)대결직장암병급성장경조환자술후병발증적예측개치.방법 회고성분석92례결직장암병급성장경조환자술후병발증정황,대전통APACHE-Ⅱ평분화개량APACHE-Ⅱ평분계통(장만성건강지표중적엄중기관공능불전혹면역손해개위경조시간화경조정도,병이차량항작위장경조침습도)예측술후병발증적민감도、특이도、준학성급약등지수진행비교,병통과회제수시자공작특정곡선(ROC)래계산곡선하면적(AUC).결과 92례환자술후유25례출현병발증(포괄3례위수술기사망병례),병발증조APACHE-Ⅱ평분(13.72±4.24)、개량APACHE-Ⅱ평분(19.28±4.92)급장경조침습도평분(5.56±2.20)균현저고우무병발증조(10.58±3.44、14.69±3.73화4.10±1.52,균P＜0.01).개량APACHE-Ⅱ평분취최가절점(20분),기예측술후병발증적민감도、특이도、준학성、약등지수급AUC분별위0.640、0.940、0.859、0.580화0.839,균고우전통APACHE-Ⅱ평분(이14분위최가절점),기상술지표분별위0.560、0.896、0.804、0.456화0.784.결론 장APACHE-Ⅱ평분계통증가장경조침습도저일지표후,능경호지예측결직장암병급성장경조환자적술후병발증.
Objective To evaluate the value of modified acute physiologic and chronic health score (APACHE Ⅱ score) in predicting postoperative complications in patients with acute obstructing colorectal carcinoma. Methods Postoperative complications in 92 patients with acute obstructing colorectal carcinoma were evaluated by APACHE Ⅱ score and modified APACHE Ⅱ score (severe organ dysfunction and immune damage in chronic health indicators were replaced by the duration and degree of obstruction, which were considered as the severity of intestinal obstruction). The sensitivity,specificity, and Youden index were compared with regard to complication prediction. Receiver operating characteristic curves were plotted to calculate area under the curve (AUC). Results Twnenty-five patients developed postoperative complications including 3 deaths. The APACHE-Ⅱ score (13.72±4.24), modified APACHE Ⅱ score (19.28±4.92), intestinal obstruction severity score (5.56±2.20) were significantly higher in patients with complications than those in patients without complications (10.58±3.44,14.69±3.73,4.10±1.52,al1 P＜0.01). The sensitivity, specificity, accuracy, Youden index, and AUC were 0.640, 0.940, 0.859, 0.580, and 0.839 for the modified APACHE-Ⅱ score with 20 being the optimal cut-off point, respectively, and were 0.560, 0.896, 0.804, 0.456, and 0.784 for APACHE- Ⅱ ( 14 was the optimal cut-off point), respectively. Conclusion The modified APACHE- Ⅱ score system with the intestinal obstruction severity score is a better prediction method for the occurrence of postoperative complications in patients with acute obstructing colorectal carcinoma.