POSSUM系统对老年患者骨科手术风险的预测研究

Study of POSSUM scoring system in predicting the risks of orthopedic surgeries for senile patients

目的探讨生理学和手术严重度评分系统(POSSUM评分系统)对中等以上骨科下肢手术的高龄患者术后并发症率和死亡率的预测价值。方法对320例行中等以上骨科下肢手术的高龄患者,应用POSSUM和P-POSSUM预测手术死亡率和并发症率,分析手术风险预测值和观察值之间的差异。同时对病例资料进行分组比较,包括以年龄、POSSUM评分为界,分析不同组别间的预测情况是否存在差异。结果根据POSSUM系统预测,107例患者术后发生并发症,而实际发生并发症95例,预测值与实际值无显著性差异(P=0.307);预测22例死亡,实际死亡8例,预测值明显高于实际值。根据P-POSSUM系统预测的死亡率(预测死亡7例,实际死亡8例),预测值与实际值无显著性差异(P=0.599)。结论POSSUM能较好的预测中等以上下肢骨科手术的高龄患者并发症率,但过高估计手术死亡率;P～POSSUM能准确地预测手术死亡率,对于高危组患者的预测结果尤为满意。

Objective To evaluate the value of the physiological and operative severity score for the enumeration of mortality and morbidity （POSSUM） and P-POSSUM in predicting the risks of orthopedic surgeries for senile patients. Methods A total of 320 patients who underwent lower limbs orthopedic surgeries were retrospectively studied with using POSSUM and P-POSSUM scoring system to predict their mortality and complication rate. The difference between predictive value and observed value was analyzed by chi-square test. Meanwhile, the patients were divided into two groups based on their age and POSSUM scores. The differences between two groups were analyzed. Results According to POSSUM scores, 107 patients were predicted to have complications, but only 95 did actually. There was no significant difference between predicted values and observed values （P=0.307）. The predicted death toll was 22, but actually only 8 patients died. Predicted value was higher than observed value. In terms of complications, death toll agreed well with the predicted values calculated by P-POSSUM （7 cases and 8 cases） without significant difference （P=0.599）. Conclusions POSSUM has better predictive ability of morbidity,but overestimates mortality, P-POSSUM more accurately predicts mortality than POSSUM. The predicted results of POSSUM and P-POSSUM scoring system are satisfactory in the high risk group.