·论著·恶性梗阻性黄疸患者围术期并发症高危因素评分系统的研发与应用王若乔1,李丽2,付立3,姜树坤4,叶志霞33摘要:目的客观、准确、快速地筛选出恶性梗阻性黄疸患者围术期并发症发生的高危人群,以采取针对性措施预防和控制并发症。方法收集整理841例恶性梗阻性黄疸行手术治疗患者的临床资料,在医学统计学教研室的帮助下完成出血、胰漏、肾功能不全的高危因素及Fisher′s判别方程的计算,与软件公司合作,将出血、胰瘘、肾功能不全高危因素分类排版,Fisher′s判别方程编入程序,形成恶性梗阻性黄疸患者围手术期并发症高危因素评分系统软件。将该软件应用于62例恶性梗阻性黄疸患者,将患者相关资料输入软件后系统筛选并发症发生的高危人群。结果评分系统软件对出血、胰瘘、肾功能不全检出的灵敏度分别为85.7%、88.9%、100%;特异度分别为94.5%、96.2%、96.5%;预测符合率分别为93.6%、95.2%、96.8%,平均每例患者的计算时间缩短426.92s。结论恶性梗阻性黄疸患者围术期并发症高危因素评分系统能快速、准确筛选出围术期并发症发生的高危人群,为预测患者围手术期情况提供参考。关键词:恶性梗阻性黄疸;围术期;高危因素;评分系统;并发症;出血;胰漏;肾功能不全中图分类号:R473.6;C931.6文献标识码:A文章编号:100124152(2010)1020001203DOI:10.3870/hlxzz.2010.10.001Inventionandapplicationofahighriskfactorscoringsystemtopredictperioperativecomplicationsformalignantobstructivejaundicepatients∥WangRuoqiao,LiLi,FuLi,JiangShukun,YeZhixia∥(GraduateDepartment,EasternHepatobiliarySurgeryHospital,Shanghai200438,China)Abstract:ObjectiveToobjectively,accuratelyandswiftlyscreenmalignantobstructivejaundicepatientswithhighriskofperioperativecom2plication,andtoprovideinformationforpreventionandcontrolofcomplications.MethodsThesurgicaldataof841malignantobstructivejaundicepatientswerecollected.Withthehelpofmedicalstatisticsteachers,suchhighriskfactorsashemorrhage,pancreaticfistulaandrenalinsufficiencywereidentifiedandFisher′sDiscriminantFunctionwascalculated.Theidentifiedperioperativecomplicationsweregroupedandtypesetwiththehelpofsoftwarecompany,whichalsoeditedFisher′sDiscriminantFunctionintoaprogram.Theprogramwasthendevelopedintoahighriskfactorscoringsystemformalignantobstructivejaundicepatients.Thedataof62patientswereinputintothesystemandthosewithhighriskofperioperativecomplicationswerescreenedout.ResultsThesoftware′ssensitivityofhemorrhage,pancreaticfistulaandrenalinsufficiencywere85.7%,88.9%and100%respectively,withthespecificitybeing94.5%,96.2%,and96.5%respectively.Thecoincidenceratesofpredictionoftheabove3complicationswere93.6%,95.2%and96.8%respectively,andthecalculationtimeforeachpatientwas426.92sshorter.ConclusionThehighriskfactorscoringsystemformalignantobstructivejaundicepatientscanbeusedtoswiftlyandconvenientlyscreenpatientswithhighriskofperioperativecomplication.Itcanprovideinformationforpredictingpatients′perioperativeconditions.Keywords:malignantobstructivejaundice;perioperativeperiod;highriskfactors;scoringsystem;complications;hemor2rhage;pancreaticfistula;renalinsufficiency作者单位:第二军医大学东方肝胆外科医院1.研究生队2.监护室3.护理部(上海200438);4紫金桥软件技术开发有限公司王若乔(19812),女,硕士在读,护师;3通讯作者科研项目:上海市重点学科建设基金项目(B903)收稿:2010201220;修回:2010203202恶性梗阻性黄疸患者围手术期并发症发生率较高,其中出血、胰漏、肾功能不全是主要的并发症,一旦发生预后较差,是导致患者术后死亡、延长住院时间及增加住院费用的主要原因[123]。如何合理评估该类患者围手术期并发症的高危因素,快速、准确地筛选出并发症发生的高危人群,针对性地预防和控制,降低并发症的发生率和病死率,是护理...
