生理学和手术侵袭度评分在肺癌手术风险预测中的应用

目的探讨生理学和手术侵袭度评分(Physiological and Operative Severity Score for the enUmeration ofMortality and Morbidity,POSSUM)预测肺癌患者术后并发症发生率和死亡率的应用价值,为临床治疗决策提供参考。方法回顾性分析2007年1月至2010年10月新疆医科大学第一附属医院住院期间接受肺癌手术治疗的179例原发性肺癌患者的临床资料,其中男124例,女55例;年龄(59.2±11.4)岁。术前应用POSSUM评分进行评分,将每位患者评分结果代入POSSUM评分的Copeland方程计算出预测的术后并发症发生率和死亡率。统计179例患者中术后实际并发症例数和死亡例数,将其分为无并发症组和有并发症组,比较两组POSSUM评分情况、并发症与死亡的实际值与预测值。对术后实际并发症和死亡发生的相关临床因素进行单因素分析。结果共有78例患者术后发生并发症,有并发症组生理学评分、手术侵袭度评分均明显高于无并发症组生理学评分:(16.11±2.53)分vs.(14.88±1.86)分,P=0.000;手术侵袭度评分:(13.47±2.83)分vs.(12.88±2.57)分,P=0.000]。POSSUM评分预测术后并发症65例,实际并发症78例,差异无统计学意义(χ2=1.968,P=0.161)。POSSUM评分预测死亡12例,实际死亡3例,差异有统计学意义(χ2=5.636,P=0.018)。单因素分析结果显示年龄、血红蛋白量、术前肺功能、手术方式和手术时间均与术后并发症的发生相关;其中仅血红蛋白量与术后死亡的发生相关。结论 POSSUM评分能较好地预测肺癌患者术后并发症,但对术后死亡存在过度预测。5个临床观察的单因素具有较好的临床应用价值。

Estimation of Operation Risk in Lung Cancer Patients Undergoing Surgery Using POSSUM

Objective To evaluate the clinical validity of Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity(POSSUM) in primary lung cancer patients undergoing surgery in order to get clinical treatment reference.Methods A total of 179 patients,with 124 males and 55 females,with primary lung cancer surgery between January 2007 and October 2010 were included in the First Affiliated Hospital of Xinjiang Medical University.Their age was 59.2±11.4 years.Before the surgery,POSSUM was used to each patient to rate the results and substituted the results into Copeland equation to calculate the predicted postoperative mortality and morbidity.The actual number of complications and death were calculated after surgery and the patients were divided into one group with postoperative complications and another group without postoperative complications.The physiological score and the operative risk score were compared between the two groups.Actual number of complications and death were compared with the number predicted by POSSUM respectively.The clinical factors related to the actual number of complications and death were analyzed.Results Among 179 patients,there were postoperative complications in 78 patients.The physiological score and the operative severity score were significantly higher in the group in whose complications occurred compared with those without complications(16.11±2.53 points versus 14.88±1.86 points for physiological score,P=0.000;13.47±2.83 points versus 12.88±2.57 points for operative severity score,P=0.000).There was no statistical difference in complication between the predicted and actual number(65/179 versus 78/179,χ2=1.968,P=0.161).There was statistical difference in death between the predicted and actual number(12/179 versus 3/179,χ2=5.636,P=0.018).Univariable analysis revealed that 5 single factors were related to the complications,only hemoglobin was related to the death.Conclusion The POSSUM gives satisfactory prediction in morbidity rate but overrates the mortality rate in primary lung cancer patients undergoing surgery,and 5 single clinical factors show a better clinical value.