3种评分方法应用于胃肠恶性肿瘤手术病人中的比较

Application of the POSSUM、M-POSSUM and APACHEⅡ score systems in patients with gastrointestinal malignant tumor

目的:分析比较M-POSSUM、POSSUM及APACHEⅡ评分在胃肠恶性肿瘤病人手术风险评估中的临床意义。方法:对2007年1月至2007年7月收治的65例胃肠恶性肿瘤手术病人,于入院后24h和术后第1天,应用POSSUM、M-POSSUM及APACHEⅡ评分法进行评估;记录住院时间、费用及并发症,进行统计学分析。结果:3种评分法的术后第1天评分值均高于入院后分值(P<0.01);评分法之间均呈显著正相关。POSSUM和M-POSSUM的术后第1天评分值与并发症呈显著正相关,而APACHEⅡ评分法于入院后及术后第1天评分值均与并发症不相关(Pearson r=0.228P=0.068;Pearson r=0.238P=0.056)。结论:M-POSSUM和POSSUM评分法较之APACHEⅡ更适用于胃肠外科恶性肿瘤病人的手术风险评估。

Objective To analyze the clinical significance of the POSSUM, M-POSSUM and APACHE Ⅱ score systems in patients with gastrointestinal malignant tumor. Methods Sixty-five patients with gastrointestinal malignant tumor undergoing surgical treatment during the period of January 2007 to July 2007 were submitted to assessment by the 3 score systems： （1）24 hrs after adnlission; （2）at postoperative d1. Their length of hospital stay and postoperative complications were recorded, then the scores were calculated and compared. Results The scores of postoperative dl by the 3 methods were significantly higher than those noted right after hospital admission （P〈0.01）; the 3 scores were all positively correlated. The POSSUM and M-POSSUM scores of postoperative d1 were significantly correlated with the complication（s）, while the scores of APACHE Ⅱ were not correlated with the complication（s）（Pearson r=0.228 P=0.068; Pearson r=0.238 P=0.056）. Conclusions The POSSUM and M-POSSUM score systems are preferable to the estimation of operative risk in patients with gastrointestinal malignant tumor than the APACHE Ⅱ.