70岁以上高龄患者的外科决策-附246例病例报告

Surgical decision making of elderly patients aged over 70 years(246 cases)

目的探讨POSSUM评分系统对高龄患者手术风险的评定意义。方法回顾性分析某普外病房2004年1月～2006年12月246例年龄在70岁以上(不含70岁)的高龄手术患者的临床资料。结果POS-SUM评分系统预测的术后并发症和死亡分别为87例(35.5%)和16例(6.5%),P-POSSUM评分系统计算的术后死亡为5例(2.0%),实际发生并发症和死亡分别为56例(22.8%)和4例(1.6%)。手术后发生并发症患者的POSSUM预测值、手术评分、住院时间、住院费用、手术时间、术中输血量均显著高于未发生并发症的患者。呼吸系统评分越高,术后并发症的发生率越高。急诊手术的术后并发症发生率较高。结论POSSUM评分系统可以协助评估高龄患者的手术风险;对于高龄患者,应该尽量缩短手术时间,减少术中出血,避免急诊手术,并注意患者呼吸系统情况。

[Objective] To investigate the POSSUM scoring system in prediction of the postoperative complication and the hospital mortality in the elderly patients.[Methods] Clinical data of 246 patients over 70 years-old between January 2004 and December 2006 in a certain surgery ward were analyzed retrospectively.[Results] POSSUM predicted 87(35.5%) postoperative complications and the observed morbidity was 56(22.8%).POSSUM predicted 16(6.5%) deaths,P-POSSUM predicted 5(2.0%) deaths and the observed mortality was 4(1...