中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
31期
2537-2541
,共5页
手术中并发症%手术后并发症%心排出量%预测%手术风险
手術中併髮癥%手術後併髮癥%心排齣量%預測%手術風險
수술중병발증%수술후병발증%심배출량%예측%수술풍험
Intraoperative complications%Postoperative complications%Cardiac output%Forecasting%Postoperative riskmorbidity
目的 探讨术前生理学与手术相关评分(POSSUM)系统在预测骨科患者术后并发症率中的应用价值.方法 2009年4月至2010年9月期间于北京医院接受骨科手术的患者共779例,根据有无并发症分为2组,利用POSSUM预测术后30 d内并发症率,预测值分别与实际值相比较,验证POSSUM评分系统的评估效能,采用多元Logistic回归分析新加入因素对术后并发症率的影响,尝试根据骨科手术特点对原始POSSUM公式进行适当改良,得到新的预测公式及出受试者工作特征曲线(ROC),描述符合程度,比较改良前后公式的预测能力变化.结果 779例中经POSSUM预测发生术后并发症212例,实际出现并发症65例.通过对新加入因素的筛选发现,心脏超声射血分数对术后并发症发生有预测价值(P＜0.01).在标准POSSUM评分中,并发症组与无并发症组比较差异有统计学意义(P＜0.01).在改良POSSUM评分中,并发症组与无并发症组比较差异有统计学意义(P＜0.01).改良POSSUM较标准POSSUM对术后并发症发生有更好的预测价值,两组AUC比较,差异有统计学意义[(0.67±0.12)比(0.75±0.08),P＜0.01].结论 POSSUM总体过高预测了骨科手术患者并发症率,经过适当改良后可以提高其预测能力.
目的 探討術前生理學與手術相關評分(POSSUM)繫統在預測骨科患者術後併髮癥率中的應用價值.方法 2009年4月至2010年9月期間于北京醫院接受骨科手術的患者共779例,根據有無併髮癥分為2組,利用POSSUM預測術後30 d內併髮癥率,預測值分彆與實際值相比較,驗證POSSUM評分繫統的評估效能,採用多元Logistic迴歸分析新加入因素對術後併髮癥率的影響,嘗試根據骨科手術特點對原始POSSUM公式進行適噹改良,得到新的預測公式及齣受試者工作特徵麯線(ROC),描述符閤程度,比較改良前後公式的預測能力變化.結果 779例中經POSSUM預測髮生術後併髮癥212例,實際齣現併髮癥65例.通過對新加入因素的篩選髮現,心髒超聲射血分數對術後併髮癥髮生有預測價值(P＜0.01).在標準POSSUM評分中,併髮癥組與無併髮癥組比較差異有統計學意義(P＜0.01).在改良POSSUM評分中,併髮癥組與無併髮癥組比較差異有統計學意義(P＜0.01).改良POSSUM較標準POSSUM對術後併髮癥髮生有更好的預測價值,兩組AUC比較,差異有統計學意義[(0.67±0.12)比(0.75±0.08),P＜0.01].結論 POSSUM總體過高預測瞭骨科手術患者併髮癥率,經過適噹改良後可以提高其預測能力.
목적 탐토술전생이학여수술상관평분(POSSUM)계통재예측골과환자술후병발증솔중적응용개치.방법 2009년4월지2010년9월기간우북경의원접수골과수술적환자공779례,근거유무병발증분위2조,이용POSSUM예측술후30 d내병발증솔,예측치분별여실제치상비교,험증POSSUM평분계통적평고효능,채용다원Logistic회귀분석신가입인소대술후병발증솔적영향,상시근거골과수술특점대원시POSSUM공식진행괄당개량,득도신적예측공식급출수시자공작특정곡선(ROC),묘술부합정도,비교개량전후공식적예측능력변화.결과 779례중경POSSUM예측발생술후병발증212례,실제출현병발증65례.통과대신가입인소적사선발현,심장초성사혈분수대술후병발증발생유예측개치(P＜0.01).재표준POSSUM평분중,병발증조여무병발증조비교차이유통계학의의(P＜0.01).재개량POSSUM평분중,병발증조여무병발증조비교차이유통계학의의(P＜0.01).개량POSSUM교표준POSSUM대술후병발증발생유경호적예측개치,량조AUC비교,차이유통계학의의[(0.67±0.12)비(0.75±0.08),P＜0.01].결론 POSSUM총체과고예측료골과수술환자병발증솔,경과괄당개량후가이제고기예측능력.
Objective To assess the use of Physical and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) scoring system in predicting outcomes of patients undergoing orthopedic surgery and provide guidance for operation treatment decisions.Methods From April 2009 to September 2010,a total of 779 cases went operation in Beijing Hospital were collected.They were divided into two groups according to the presence or absence of complications.The patients' postoperative complications were predicted by POSSUM and compared to the actual morbidity to verify the effectiveness of the equation.Logistic regression was taken to make appropriate improvements for the POSSUM equation.ROC curve was drawn to describe the compliance of the original and new equations.Results In the 779 cases,the morbidity predicted by POSSUM is 212 cases while the actual morbidity is 65 cases.Of all risk factors,echocardiography ejection fraction showed a close relationship with postoperative complications (P ＜0.01).In the original equation,actual complication group compared with non-complication group,the difference was statistically significant (P ＜ 0.01).In the modified equation,complication group compared with non-complication group,the difference was statistically significant (P ＜0.01).Compared with the original one,the modified POSSUM had better predictive value on postoperative morbidity,and the comparison of AUC between the two groups was statistically significant ((0.67 ± 0.12) vs (0.75 ± 0.08),P＜0.01).Conclusion POSSUM over predicted morbidity of patients undergoing orthopedic surgery,it can be more accurate when modified appropriately.
