摘要
目的通过比较分析老年骨科患者围手术期风险评分（PRESGOP）与急性生理及慢性健康状况评分（APACHE）、计数死亡率和发病率的生理学和手术严重性评分（POSSUM）的有效性、相关性及预测的准确性，探讨PRESGOP评分在预测老年骨科患者术后并发症和死亡率方面的效能。方法2009年1月至2010年2月，收集所有入骨科的65岁以上患者资料，按照PRESGOP、APACHE、POSSUM评分表分别计算评分结果。剔除未进行手术治疗的患者，再记录术后预后情况，共纳入401例患者。按照有无并发症、有无死亡分别分成2组，依次对PRESGOP、APACHE、POSSUM评分结果进行分析，另比较3种评分结果间的相关性以及预测术后并发症和死亡率ROC曲线的曲线下面积的差异。结果有并发症组和无并发症组比较，3种评分结果差异均有统计学意义（P〈0．05）。死亡组和存活组比较，仅PRESGOP评分差异有统计学意义（P〈0．05）。3种评分间两两相关（P〈0．05）。PRES—GOP、APACHE、POSSUM3种评分总分与不良预后所得ROC曲线下面积分别为0．771、0．634、0．751，3种评分差异均有统计学意义（P〈0．05）。预测死亡率ROC曲线下面积分别为0．920、0．877、0．836，仅PRESGOP评分差异有统计学意义（P〈0．05）。结论PRESGOP、APACHE、POSSUM3种评分在老年骨科患者评价方面具有良好相关性，在预测骨科老年手术后并发症和死亡率方面同样有效，PRESGOP的效能相对更加准确。
Objective To evaluate the correlation and efficacy of Preoperative Risk Evaluation System for Geriatric Orthopedic Patients （PRESGOP）, Acute Physiology and Chronic Health Evaluation （APACHE） and Physiological and Operative Score for the Enumeration of Mortality and Morbidity （POSSUM） in predicting the postoperative complications and mortality in old orthopedic patients. Methods From January, 2009 to February, 2010, 401 geriatric orthopedic patients who underwent surgery in our department were enrolled in the present prospective trial. All cases were divided into 4 groups according to presence or absence of complication and death respectively. The 4 groups were evaluated by PRESGOP, APACHE and POSSUM scoring systems and then compared using T test. The 3 kinds of scores were also compared for their correlations and Receiver Operating Charaeteristie（ROC） curves. Results Comparisons of the complication and complication-free groups, only in PRESGOP death and death-free groups have significant differences（ P 〈 0.05）. The Pearson correlative coefficient of PRESGOP and APACHE was 0. 300, while that of PRESGOP and POSSUM was 0. 538. The correlative coefficient of APACHE and POSSUM was 0. 490. The areas under ROC curve associated with 3 total scores accumulated and complications were 0. 771 （PRESGOP）, 0. 634 （APACHE）, and O. 751 （POSSUM）. And the areas under ROC curve depicted by 3 predictive mortalities were 0. 920 （PRESGOP）, 0. 877 （APACHE）, and 0. 836 （POSSUM） . Conclusions The 3 evaluation systems are correlative and valid in predicting postoperative complications and mortality in old orthopedic patients. The PRESGOP system may be more exact in predictive efficacy for Chinese old orthopaedic patients.
出处
《中华创伤骨科杂志》
CAS
CSCD
2011年第2期140-143,共4页
Chinese Journal of Orthopaedic Trauma
关键词
老年
围手术期
风险
评估
Geriatric
Peroperative period
Risk
Evaluation
