E-PASS评分系统用于评估老龄患者消化道手术后并发症和转归的临床价值研究

Clinical Value of E-PASS System in the Evaluation of the Postoperative Complications and Outcomes of Elderly Patients Undergoing Digestive Surgery

目的:评价日常活动和手术应激评估(Estimation of physiologic ability and surgical stress,E-PASS)系统用于评估老龄患者消化道手术后并发症和转归的临床价值。方法:回顾性分析2011年7月至2013年7月西京医院消化外科所有65岁以上的患者的临床资料,计算其中行消化道手术者的E-PASS评分,并记录这些患者术后并发症的发生情况和患者术后的住院时间。分析E-PASS评分和几项该评分未涉及的因素与老龄患者消化道手术后并发症的发病率、死亡率、住院时间的相关性。结果:研究共纳入1236例老龄行消化道手术的患者,其中521例发生术后并发症(42.15%),8例死亡(0.65%)。患者术前E-PASS评分系统中,三项评分均与术后住院时间相关,术前风险评分(Preoperative risk score,PRS)和综合风险评分(Comprehensive risk score,CRS)与术后并发症的发病率和死亡率显著相关(P均<0.05)。E-PASS评分系统未包含的指标中,麻醉方法与术后并发症发生和住院时间无关,术后入ICU、术中使用血管活性药物和急诊手术与术后发病率、死亡率和住院时间相关(P均<0.05)。结论:E-PASS评分系统可用于预测老龄患者行消化道手术后并发症的发生情况和转归,纳入术后入ICU、术中使用血管活性药物和急诊手术三项指标可能进一步提高E-PASS评分系统的预测准确性。

Objective： To assess the cliniacl value of Estimation of physiologic ability and surgical stress（E-PASS） system in the evaluation of the postoperative complications and outcomes of elderly patients undergoing digestive surgery. Methods： Patients65 yrs old who underwent digestive surgery in Xijing hospital from July 2011 to July 2013 were enrolled. E-PASS scores were used to calculate for each patient. Complications and postoperativehospital stay were recorded. The relationships between E-PASS scores or some optional risk factors and morbidity, mortality or hospital stay were analyzed. Results： 1236 patients underwent digestive surgery were analyzed, in which 521 suffered from complications（42.15%）, 8 were dead（0.65%）. All the three scores of E-PASS were related to hospital stay postoperatively, while only preoperative risk score（PRS） and comprehensive risk score（CRS） were related to the postoperative morbidity and mortality（all P0.05）. Anesthetic technique（inhaled or intravenous） was not related to postoperative outcomes. However,transportation to ICU, use of vasoactive agents during the surgery and emergency cases was related to morbidity, mortality and hospital stay（all P0.05）. Conclusion： E-PASS scoring system could predict the postoperative outcome of elderly patients undergoing digestive surgery. Integrating admission in ICU, use of vasoactive agents during the surgery and emergency case into the system might improve its accuracy.