改良Possum评分系统对胸外科术后患者并发症及手术死亡的预测价值

Value of Modified Possum Scoring System in Predicting Complications and Death after Thoracic Surgery

目的探讨改良Possum评分系统对胸外科术后患者并发症及手术死亡的预测价值。方法选取2002年1月—2004年4月河北医科大学第四医院胸外科住院行手术治疗的患者1 287例为研究对象,进行Possum评分。将手术时间纳入Possum评分系统中,采用Logistic回归方法建立回归方程,建立改良Possum(T-Possum)评分系统。同时比较Possum评分和T-Possum评分对胸外科术后患者并发症和手术死亡的预测结果。结果共有511例患者术后发生并发症,手术死亡18例。Logistic回归方法建立T-Possum评分方程为:ln〔R1/(1-R1)〕=-6.18+(0.24×生理学得分)+(0.15×手术侵袭度得分);ln〔R2/(1-R2)〕=-7.92+(0.15×生理学得分)+(0.13×手术侵袭度得分),其中R1为术后并发症发生概率,R2为手术死亡发生概率。Possum评分和T-Possum评分对胸外科术后并发症的预测值与实际值比较,差异无统计学意义(χ2=4.4059,P=0.1105)。Possum评分和T-Possum评分对胸外科手术死亡的预测值与实际值比较,差异有统计学意义(χ2=84.8554,P=0.0000);其中Possum评分预测值与T-Pos-sum评分预测值比较,差异有统计学意义(χ2=46.7987,P=0.000);Possum评分预测值与实际值比较,差异有统计学意义(χ2=53.9175,P=0.0000);T-Possum评分预测值与实际值比较,差异无统计学意义(χ2=0.4063,P=0.5238)。结论 T-Possum评分在预测手术死亡方面优于Possum评分,与实际值更接近,可用于预测胸外科手术患者术后并发症和手术死亡。

Objectives To Assess the value of modified Possum scoring system in predicting complications and death after thoracic surgery. Methods Possum scoring was carried out in 1 287 patients receiving thoracic surgery from January 2002 to April 2004. Operation time was fitted into Possum scoring system, Logistic regression method used to establish regression e- quation and then T - Possum scoring system. The predicting results of complications and death after operation were compared be- tween systems Possum and T - Possum. Results A total of 511 patients had post - operative complications, 18 died. T - Pos- sum scoring equation： In [ R1/ （ 1 - R1 ） ] = - 6. 18 ＋ （0.24 x physiological scores） ＋ （0. 15 x degree of surgical inva- sion） ; In [ R2/ （ 1 - R2 ） ] = -7. 92 ＋ （0. 15 x physiological scores） ＋ （0. 13 x degree of surgical invasion）, thereinto R1 stood for happening probability of complications, R2 for that of death. No significant difference was noted in complication predic- tion and actual value between systems Possum and T- Possum （X2 = 4. 4059, P = 0. 1105 ） , but there was in death prediction and actual value （X2 = 84. 8554, P = 0. 0000）. There was not difference between Possum score and actual value （X2 = 53. 9175, P = 0. 0000）, or between T - Possum score and actual value （ X2 = 0. 4063, P = 0. 5238 ）. Conclusion T - POS- SUM Scoring System is suitable to predict morbidity and mortality after thoracic surgery.