匹兹堡评分系统联合共病指数评分对良性食管穿孔的预后评估

Prognostic evaluation of benign esophageal perforation with perforation severity score and Charlson comorbidity index score

目的研究食管穿孔匹兹堡评分系统(perforation severity scores,PSS)联合共病指数(Charlsoncomorbidity index,CCI)对良性食管穿孔的预后评估。方法选取我院2016年8月至2018年8月经影像学或内镜确诊食管穿孔的患者30例,其中男14例、女16例,年龄(68.660±10.072)岁。经治疗后回顾性分析患者在治疗过程中有无并发症、出院时食管穿孔愈合情况及出院后随访等。将患者分为两组:病情稳定组20例(无并发症、出院时明确食管穿孔已愈合、随访无死亡)和病情不稳定组10例(存在并发症、出院时食管穿孔未愈、随访死亡)。所有患者均取得完整的临床数据,均能进行PSS及CCI评分系统的计算得分,比较两组患者的PSS和CCI评分的差异性,分析PSS联合CCI评分在良性食管穿孔预后的临床价值。结果稳定组患者PSS为(2.750±1.372)分[95%CI(2.110,3.390)],CCI评分(2.080±1.055)分[95%CI(1.650,2.500)],差异有统计学意义(P=0.000)。不稳定组PSS为(7.300±1.829)分[95%CI(7.300,8.120)],CCI评分(4.640±1.287)分[95%CI(4.220,5.060)],差异有统计学意义(P=0.000)。PSS和CCI评分在良性食管穿孔预后评估中的受试者工作特征(ROC)曲线下面积分别为0.982和0.870,差异具有统计学意义(P<0.05)。结论食管穿孔病情凶险,通过PSS及CCI评分能在首诊时全面认识、评估病情,对患者临床管理具有重要的实用价值。

Objective To evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI). Methods Thirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed. Results In the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively,which was statistically significant (P<0.05). Conclusion Esophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.