生理学和手术严重程度评分在老年急腹症患者围术期监测及治疗中的应用

目的探讨生理学和手术严重程度评分（POSSUM评分）用于指导老年急腹症患者围术期监测及治疗的价值。方法选取浙江中医药大学附属宁波市中医院106例老年急腹症手术患者，按就诊时期分为2组：A组57例，围术期不评分，仅依据医师经验进行监测与治疗，对病历资料进行回顾性评分；B组49例，在术后立即进行POSSUM评分并依此指导治疗。比较2组术后并发症发生情况和病死率，同时比较所有患者实际并发症发生情况、病死率与评分预测值间的差异。结果所有患者并发症发生率（X^2=6．97，P=0．47）和病死率（X^2=3．27，P=0．39）评分预测值（89．1％、18．7％）与实际值（78．0％、11．1％）差异无统计学意义（P〉0．05）；而B组术后并发症发生率30．6％（15／49）]低于A组的47．4％（27／57）]，组间差异有统计学意义（X^2=4．52，P=0．043）。结论POSSUM评分能较好地预示老年急腹症患者手术后并发症和死亡的发生。在其预警下做好围术期治疗，有助于减少术后并发症。

Value of physiological and operative severity score for the enumeration of mortality and morbidity for the perioperative management in elderly patients with acute abdomen undergoing resection

Objective To evaluate the physiological and operative severity score for the enumeration of mortality and morbidity system for the perioperative monitoring and management of elderly patients with acute abdo- men undergoing resection. Methods In this study, 106 perioperative cases were divided into two groups. Group A was not evaluated by the POSSUM system and managed empirically; group B was recorded by POSSUM immediately at the end of operation and managed accordingly. Postoperative morbidity and mortality was compared between the two groups. Results All patients complication rate （X^2 = 6.97, P = 0.47 ） and mortality （X^2 = 3.27, P = 0.39） score predictive value （89.1%, 18.7%） and the actual value （78.0%, 11.1%） showed no statistical signifi- cance （ P 〉 0.05 ） ; the incidence of postoperative complications in group B （ 30.6% ） was lowere than that in group A （47. 4% ）; there were statistically significant difference between two groups （X^2 = 4. 52, P = 0. 043 ）. Conclusion The POSSUM methodology allows satisfactory prediction of mortality and morbidity rates in elderly pa- tients with acute abdomen undergoing resection.