中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

匹兹堡评分系统联合共病指数评分对良性食管穿孔预后评估

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目的 研究食管穿孔匹兹堡评分系统(perforation severity scores,PSS)联合共病指数(charlson comorbidity index,CCI)对良性食管穿孔的预后评估。 方法 选取我院 2016 年 8 月至 2018 年 8 月经影像学或内镜确诊食管穿孔的患者 30 例,其中男 14 例、女 16 例,年龄(68.660±10.072)岁。经治疗后回顾性分析患者在治疗过程中有无并发症、出院时食管穿孔愈合情况及出院后随访等,将患者分为两组:病情稳定组 20 例(无并发症、出院时明确食管穿孔已愈合、随访无死亡)和病情不稳定组 10 例(存在并发症、出院时食管穿孔未愈、随访死亡)。所有患者均取得完整的临床数据,均能进行 PSS 及 CCI 评分系统的计算得分,比较两组患者的 PSS 和 CCI 评分的差异性,分析 PSS 联合 CCI 评分在良性食管穿孔预后的临床价值。 结果 稳定组患者 PSS 为(2.750±1.372)分,95%CI(2.110,3.390);CCI 评分(2.080±1.055)分,95%CI(1.650,2.500);差异有统计学意义(P=0.000);不稳定组 PSS 为(7.300±1.829)分,95%CI(7.300,8.120);CCI 评分(4.640±1.287)分,95%CI(4.220,5.060);差异有统计学意义(P=0.000)。PSS 和 CCI 评分在良性食管穿孔预后评估中的曲线下面积分别为 0.982 和 0.870,差异具有统计学意义(P<0.05)。 结论 食管穿孔病情凶险,通过 PSS 及 CCI 评分能在首诊时全面认识、评估病情,对患者进行临床管理具有重要的实用价值。

Objective To evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (charlson comorbidity index, CCI). Methods Thirty patients with esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there were any complications in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge, and the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge) and an unstable condition group (10 patients with complications, esophageal perforation at discharge, deaths during follow up). All the patients obtained complete clinical data and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed. Results In the stable group, the PSS was 2.750±1.372 (95% CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) and the difference between two systems was statistically significant (P=0.000). In unstable group, PSS was 7.300 ±1.829 (95% CI 7.300 to 8.120), CCI was 4.640±1.287 (95% CI 4.220 to 5.060), and the difference was statistically significant (P<0.05). The area under the curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation were 0.982 and 0.870 respectively, which was statistically significant (P<0.05). Conclusion Esophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.

关键词: 匹兹堡评分系统(PSS); 共病指数(CCI); 良性食管穿孔

Key words: Pittsburgh scoring system; comorbidity index; benign perforation of esophagus

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