外科阿普加評分在評估胰腺癌患者術(shù)后死亡及并發(fā)癥發(fā)生風(fēng)險(xiǎn)中的應(yīng)用
發(fā)布時(shí)間：2019-02-09 13:08
【摘要】：研究目的： 胰腺癌是美國第四大癌癥相關(guān)死亡的病因,手術(shù)切除仍是胰腺癌唯一可能治愈的治療方法。雖然在手術(shù)設(shè)備和技術(shù)等方面取得了較大進(jìn)展,然而胰腺癌患者的5年生存率仍然較低,一些大樣本的研究表明胰腺癌術(shù)后并發(fā)癥的發(fā)生率高達(dá)40%-43%。對可能導(dǎo)致術(shù)后不良結(jié)果的危險(xiǎn)因素進(jìn)行評分被證實(shí)有較大獲益。臨床上存在很多評分系統(tǒng),一些復(fù)雜的評分系統(tǒng)如急性生理與慢性健康評分系統(tǒng)(APACHE)、并發(fā)癥和病死率的生理和手術(shù)嚴(yán)重性評分系統(tǒng)(POSSUM和P-POSSUM)能很好地預(yù)測手術(shù)病人術(shù)后發(fā)生并發(fā)癥的風(fēng)險(xiǎn)。然而,由于這些評分系統(tǒng)需要采集大量數(shù)據(jù)并經(jīng)過非常復(fù)雜的計(jì)算,不能很方便地在床邊進(jìn)行計(jì)算,其結(jié)果也較難解讀。Gawande等人于2007年提出一個(gè)通過計(jì)算術(shù)中的三個(gè)變量：估計(jì)失血量(estimated blood loss, EBL),最低心率(heart rate, HR)及最低平均動(dòng)脈壓(mean arterial pressure, MAP)而得到的總分為10分的評分系統(tǒng),即外科阿普加評分(surgical apgar score, SAS)。在其包含767名行普通外科手術(shù)或血管外科手術(shù)患者的試點(diǎn)研究中,發(fā)現(xiàn)術(shù)后30天內(nèi),SAS評分的高低與主要并發(fā)癥或死亡發(fā)生的風(fēng)險(xiǎn)緊密相關(guān)。本研究的目的即為探索外科阿普加評分(SAS)是否能有效評估胰腺癌術(shù)后死亡及并發(fā)癥的發(fā)生風(fēng)險(xiǎn),且目前國內(nèi)文獻(xiàn)尚未有相關(guān)研究報(bào)道。 材料和方法： 本研究回顧性分析2007年1月至2012年12月行胰腺手術(shù)并且術(shù)后病理證實(shí)為胰腺癌的222例患者的臨床資料。 結(jié)果： SAS5分患者中有81.8%發(fā)生術(shù)后并發(fā)癥,SAS6分有44%發(fā)生并發(fā)癥,兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.001)。SAS5分患者中有40.9%(9/22)發(fā)生胰漏,SAS6分有16.0%(32/200)發(fā)生胰漏(P=0.004)。所有死亡者SAS評分均≤5分。PD組并發(fā)癥及胰漏的發(fā)生率均顯著高于非PD組。PD組手術(shù)時(shí)間及術(shù)中出血量均顯著高于非PD組,但術(shù)中最低心率及最低平均動(dòng)脈壓兩組無明顯差異。進(jìn)而,SAS評分能較好地評估非PD術(shù)患者術(shù)后并發(fā)癥及胰漏的風(fēng)險(xiǎn),在PD組中則無明顯評估作用。此外,SAS評分還能較好地評估患者住院時(shí)間及住院費(fèi)用。 結(jié)論： 外科阿普加評分(SAS)不僅是一種簡單、快速的評分系統(tǒng),還能有效評估胰腺癌患者非PD術(shù)后并發(fā)癥及胰漏的發(fā)生風(fēng)險(xiǎn),但對于PD術(shù)后并發(fā)癥及胰漏的發(fā)生風(fēng)險(xiǎn)及死亡風(fēng)險(xiǎn)的評估作用還不明確,需要進(jìn)一步研究證實(shí)。SAS評分將有助于合理分配醫(yī)療資源,使術(shù)后發(fā)生并發(fā)癥或死亡風(fēng)險(xiǎn)更大的患者得到更充分的治療。
[Abstract]:Objective: pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Surgical resection is still the only possible cure for pancreatic cancer. Although great progress has been made in surgical equipment and techniques, the 5-year survival rate of patients with pancreatic cancer is still low. Some large studies have shown that the incidence of postoperative complications of pancreatic cancer is as high as 40 to 43. Scoring risk factors that could lead to adverse postoperative outcomes proved to be a significant benefit. There are many clinical scoring systems, some complex scoring systems such as acute physiology and chronic health scoring system (APACHE), The physiological and operative severity scoring system (POSSUM and P-POSSUM) for complications and mortality can well predict the risk of postoperative complications. However, because these scoring systems need to collect a lot of data and go through very complicated calculations, they cannot be easily calculated by the bedside. In 2007, Gawande et al proposed three variables: estimated blood loss, (estimated blood loss, EBL), minimum heart rate (heart rate, HR) and minimum mean arterial pressure (mean arterial pressure,). MAP), or surgical Apgar score, (surgical apgar score, SAS)., for a total of 10 points. In its pilot study of 767 patients undergoing general or vascular surgery, it was found that SAS scores were closely correlated with the risk of major complications or deaths within 30 days of surgery. The purpose of this study is to investigate whether the surgical Apgar score (SAS) can effectively assess the risk of postoperative death and complications of pancreatic cancer. Materials and methods: the clinical data of 222 patients with pancreatic cancer confirmed by pathology from January 2007 to December 2012 were analyzed retrospectively. Results: postoperative complications occurred in 81.8% of SAS5 patients and 44% in SAS6 scores. The difference between the two groups was statistically significant (P0. 001). Pancreatic leakage occurred in 40.9% (9 / 22) of SAS5 patients. The SAS6 score was 16.0% (32 / 200) with pancreatic leakage (P0. 004). The incidence of complications and pancreatic leakage in PD group was significantly higher than that in non-PD group. The operative time and intraoperative bleeding volume in PD group were significantly higher than those in non-PD group. However, there was no significant difference in minimum heart rate and mean arterial pressure between the two groups. Furthermore, SAS score could evaluate the risk of postoperative complications and pancreatic leakage in non-PD patients, but not in PD group. In addition, the SAS score can also be used to evaluate the length of stay and the cost of hospitalization. Conclusion: surgical Apgar score (SAS) is not only a simple and rapid scoring system, but also an effective assessment of postoperative complications and the risk of pancreatic leakage in patients with pancreatic cancer. However, the evaluation of complications after PD and the risk of pancreatic leakage and death is not clear, and further research is needed. SAS score will be helpful for rational allocation of medical resources. Patients who have a greater risk of postoperative complications or death are more adequately treated.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.9
本文編號：2418994
[Abstract]:Objective: pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Surgical resection is still the only possible cure for pancreatic cancer. Although great progress has been made in surgical equipment and techniques, the 5-year survival rate of patients with pancreatic cancer is still low. Some large studies have shown that the incidence of postoperative complications of pancreatic cancer is as high as 40 to 43. Scoring risk factors that could lead to adverse postoperative outcomes proved to be a significant benefit. There are many clinical scoring systems, some complex scoring systems such as acute physiology and chronic health scoring system (APACHE), The physiological and operative severity scoring system (POSSUM and P-POSSUM) for complications and mortality can well predict the risk of postoperative complications. However, because these scoring systems need to collect a lot of data and go through very complicated calculations, they cannot be easily calculated by the bedside. In 2007, Gawande et al proposed three variables: estimated blood loss, (estimated blood loss, EBL), minimum heart rate (heart rate, HR) and minimum mean arterial pressure (mean arterial pressure,). MAP), or surgical Apgar score, (surgical apgar score, SAS)., for a total of 10 points. In its pilot study of 767 patients undergoing general or vascular surgery, it was found that SAS scores were closely correlated with the risk of major complications or deaths within 30 days of surgery. The purpose of this study is to investigate whether the surgical Apgar score (SAS) can effectively assess the risk of postoperative death and complications of pancreatic cancer. Materials and methods: the clinical data of 222 patients with pancreatic cancer confirmed by pathology from January 2007 to December 2012 were analyzed retrospectively. Results: postoperative complications occurred in 81.8% of SAS5 patients and 44% in SAS6 scores. The difference between the two groups was statistically significant (P0. 001). Pancreatic leakage occurred in 40.9% (9 / 22) of SAS5 patients. The SAS6 score was 16.0% (32 / 200) with pancreatic leakage (P0. 004). The incidence of complications and pancreatic leakage in PD group was significantly higher than that in non-PD group. The operative time and intraoperative bleeding volume in PD group were significantly higher than those in non-PD group. However, there was no significant difference in minimum heart rate and mean arterial pressure between the two groups. Furthermore, SAS score could evaluate the risk of postoperative complications and pancreatic leakage in non-PD patients, but not in PD group. In addition, the SAS score can also be used to evaluate the length of stay and the cost of hospitalization. Conclusion: surgical Apgar score (SAS) is not only a simple and rapid scoring system, but also an effective assessment of postoperative complications and the risk of pancreatic leakage in patients with pancreatic cancer. However, the evaluation of complications after PD and the risk of pancreatic leakage and death is not clear, and further research is needed. SAS score will be helpful for rational allocation of medical resources. Patients who have a greater risk of postoperative complications or death are more adequately treated.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.9
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 ;微言[J];八小時(shí)以外;2011年12期
，本文編號：2418994
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