M-POSSUM和NRS2002在预测普外科手术风险中的临床意义

Clinical significance of the M-POSSUM, NRS2002 in predicting surgical risk of general surgery

目的 :运用M-POSSUM、NRS2002对普通外科腹部大手术患者手术风险进行评估,评价其在预测术后并发症和死亡率方面的效果。方法:采用连续定点抽样,对121例普外科腹部大手术患者进行M-POSSUM评分、NRS2002评分,比较两者预测手术后并发症和死亡率的受试者工作特性(ROC)曲线,并记录术后1、3、7 d血清白蛋白、前白蛋白水平及并发症情况。结果:并发症组的M-POSSUM与NRS2002评分及两者结合评分明显高于无并发症组,差异有统计学意义(P<0.05),死亡组的M-POSSUM与NRS2002评分显著高于存活组(P<0.05)。M-POSSUM、NRS2002评分及两者结合预测并发症的曲线下面积(AUC)分别是0.795、0.714、0.826;预测死亡率的AUC分别是0.904、0.871、0.935。术后1、3、7 d,白蛋白和前白蛋白均较术前显著降低(P<0.05),无并发症患者组术后7 d的白蛋白和前白蛋白数值明显回升(P<0.05),而有并发症患者组与术后3 d差异无统计学意义(P>0.05)。结论:M-POSSUM评分、NRS2002评分能有效预测普通外科手术后的并发症和死亡率,腹部大手术患者营养风险较高,白蛋白和前白蛋白在术后均较术前显著降低,提示并发症的发生率可能增高。

Objective： To evaluate the effect of M-POSSUM and NRS2002 in predicting the postoperative complications and mortality of abdominal surgery in general surgery. Methods： The M-POSSUM score and NRS2002 score of 121 patients undergoing abdominal major surgery in De- partment of general surgery were measured by continuous fixed-point sampling, and the receiver operating characteristic （RQC） curve was compared between the two methods. The levels of serum albumin, prealbumin and complications were recorded 1, 3 and 7 days after operation. Results： The scores of M-POSSUM and NRS2002 in the complication group were significantly higher than those in the non complication group. The difference was statistically significant （P〈0.05）. The scores of M-POSSUM and NRS2002 in the death group were significantly higher than those in the survival group（P〈0.05）. The area under curve（AUC） of M-POSSUM, NRS2002 score and the combination of the two methods were 0.795, 0.714 and 0.826 respectively. The AUC for predicting mortality were 0.904, 0.871, and 0.935, respectively. Albumin and prealbumin were significantly lower than those before operation on 1 day, 3 day and 7 day（P〈0.05）. The values of albumin and prealbumin in the pa- tients without complications increased significantly on the 7 day after surgery（P〈0.05）. There was no significant difference between the patients with complications and the 3 days after operation（P〉0. 05）. Conclusion： M-POSSUM score and NRS2002 score can effectively predict the complications and mortality after general surgew. Patients with major abdominal surgery have higher nutritional risk, and albumin and prealbumin are significantly lower than those before operation, suggesting that the incidence of complications may increase.