外科阿普加评分在评估胰腺癌患者术后死亡及并发症发生风险中的应用
发布时间：2019-02-09 13:08
【摘要】：研究目的： 胰腺癌是美国第四大癌症相关死亡的病因,手术切除仍是胰腺癌唯一可能治愈的治疗方法。虽然在手术设备和技术等方面取得了较大进展,然而胰腺癌患者的5年生存率仍然较低,一些大样本的研究表明胰腺癌术后并发症的发生率高达40%-43%。对可能导致术后不良结果的危险因素进行评分被证实有较大获益。临床上存在很多评分系统,一些复杂的评分系统如急性生理与慢性健康评分系统(APACHE)、并发症和病死率的生理和手术严重性评分系统(POSSUM和P-POSSUM)能很好地预测手术病人术后发生并发症的风险。然而,由于这些评分系统需要采集大量数据并经过非常复杂的计算,不能很方便地在床边进行计算,其结果也较难解读。Gawande等人于2007年提出一个通过计算术中的三个变量：估计失血量(estimated blood loss, EBL),最低心率(heart rate, HR)及最低平均动脉压(mean arterial pressure, MAP)而得到的总分为10分的评分系统,即外科阿普加评分(surgical apgar score, SAS)。在其包含767名行普通外科手术或血管外科手术患者的试点研究中,发现术后30天内,SAS评分的高低与主要并发症或死亡发生的风险紧密相关。本研究的目的即为探索外科阿普加评分(SAS)是否能有效评估胰腺癌术后死亡及并发症的发生风险,且目前国内文献尚未有相关研究报道。 材料和方法： 本研究回顾性分析2007年1月至2012年12月行胰腺手术并且术后病理证实为胰腺癌的222例患者的临床资料。 结果： SAS5分患者中有81.8%发生术后并发症,SAS6分有44%发生并发症,两组差异具有统计学意义(P=0.001)。SAS5分患者中有40.9%(9/22)发生胰漏,SAS6分有16.0%(32/200)发生胰漏(P=0.004)。所有死亡者SAS评分均≤5分。PD组并发症及胰漏的发生率均显著高于非PD组。PD组手术时间及术中出血量均显著高于非PD组,但术中最低心率及最低平均动脉压两组无明显差异。进而,SAS评分能较好地评估非PD术患者术后并发症及胰漏的风险,在PD组中则无明显评估作用。此外,SAS评分还能较好地评估患者住院时间及住院费用。 结论： 外科阿普加评分(SAS)不仅是一种简单、快速的评分系统,还能有效评估胰腺癌患者非PD术后并发症及胰漏的发生风险,但对于PD术后并发症及胰漏的发生风险及死亡风险的评估作用还不明确,需要进一步研究证实。SAS评分将有助于合理分配医疗资源,使术后发生并发症或死亡风险更大的患者得到更充分的治疗。
[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.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.9
本文编号：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.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.9
【参考文献】
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1 ;微言[J];八小时以外;2011年12期
，本文编号：2418994
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