改良APACHE-Ⅱ评分对结直肠癌并急性肠梗阻患者术后并发症的预测价值

Value of modified APACHE Ⅱ score in predicting postoperative complications in patients with acute obstructing colorectal carcinoma

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.

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.