高龄急诊患者的外科风险评估(附146例报告)

Surgical risk assessment among elderly emergency patients: a report of 146 cases

目的探讨预测高龄急诊患者术后转归的方法,为提高高龄急诊患者手术安全性提供依据。方法回顾性分析北京大学第一医院普通外科2009年1月-2010年12月收治的146例高龄急诊手术患者的临床资料,其中男63例,女83例,年龄71～95岁(77.9±5.2)岁。采用POSSUM评分系统计算术后并发症发生率和术后死亡率,采用P-POSSUM评分系统计算术后死亡率,并与实际结果相比较。结果 POSSUM评分系统预测的术后发生并发症及死亡的病例分别为91例(62.3%)和30例(20.5%),P-POSSUM评分系统预测的术后死亡的病例为15例(10.3%),实际发生并发症和死亡的病例分别为74例(50.7%)和5例(3.4%)。手术后发生并发症的患者手术侵袭度评分、住院时间、住院费用均明显高于未发生并发症者(P<0.01)。手术时间越长,并发症的发生率越高。结论 POSSUM和P-POSSUM评分系统可较准确地预测高龄急诊患者的术后并发症发生率和死亡率。对于接受急诊手术的高龄患者,应尽量缩短手术时间,以减少术后并发症。

Objective The current study aims to investigate the methods of prediction of postoperative outcome and to provide the foundation for improving the safety of operations among elderly emergency patients.Methods Clinical data of 146 elderly emergency patients admitted between January 2009 and December 2010 to Department of General Surgery of Peking University First Hospital were analyzed retrospectively.Among them,63 patients were male and 83 were females,with age ranging from 71 to 95（77.9±5.2）.The POSSUM score system was used to calculate the occurrence of postoperative complications and mortality.The P-POSSUM score system was used to calculate postoperative mortality and to compare with the actual results.Results The postoperative complications were 91（62.3%） and morbidity was 30（20.5%） based on the POSSUM system.On the other hand,the predicted postoperative mortality was determined to be 15（10.3%）,whereas the occurrence of actual complications and death was 74（50.7%） and 5（3.4%）,respectively,based on the P-POSSUM score system.The score of operative severity,length of hospital stay,and hospitalization cost of patients with postoperative complications were significantly higher compared with patients without postoperative complications（P〈0.01）.The longer the operation time,the more postoperative complications occurred.Conclusions POSSUM score and P-POSSUM score can predict the occurrence of postoperative complications and mortality.The duration of surgery should be shortened as much as possible for elderly emergency patients to reduce postoperative complications.