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中华普通外科学文献(电子版) ›› 2016, Vol. 10 ›› Issue (03) : 205 -208. doi: 10.3877/cma.j.issn.1674-0793.2016.03.010

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论著

HIV感染患者手术风险评分表的设计和应用
刘保池1,(), 冯铁男1, 李垒1, 司炎辉1, 刘启领1, 张伟伟1, 刘新1   
  1. 1. 201508 上海市公共卫生临床中心外科
  • 收稿日期:2015-12-13 出版日期:2016-06-01
  • 通信作者: 刘保池

Design and utility of surgical risk score assessment for HIV-infected patients

Baochi Liu1,(), Tienan Feng1, Lei Li1, Yanhui Si1, Qiling Liu1, Weiwei Zhang1, Xin Liu1   

  1. 1. Department of Surgery, Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai 201508, China
  • Received:2015-12-13 Published:2016-06-01
  • Corresponding author: Baochi Liu
  • About author:
    Corresponding author: Liu Baochi, Email:
引用本文:

刘保池, 冯铁男, 李垒, 司炎辉, 刘启领, 张伟伟, 刘新. HIV感染患者手术风险评分表的设计和应用[J/OL]. 中华普通外科学文献(电子版), 2016, 10(03): 205-208.

Baochi Liu, Tienan Feng, Lei Li, Yanhui Si, Qiling Liu, Weiwei Zhang, Xin Liu. Design and utility of surgical risk score assessment for HIV-infected patients[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(03): 205-208.

目的

设计HIV感染者手术风险评分表,综合分析患者手术后脓毒症和病死率风险。

方法

对2009年1月至2015年6月上海市公共卫生临床中心外科851例HIV感染手术患者的临床数据进行回顾性统计分析,将CD4 T细胞水平、手术切口分类、手术分级、机会性感染、器官功能这5项指标分别分为4个级别,分别赋予1分、2分、3分和4分,检测评估表的敏感度和特异度。

结果

手术后264例(31.0%)发生脓毒症。其中手术后30 d内死亡11例,均死于重度脓毒症,术后病死率1.3%。用评分表进行手术风险评估,分隔阈值为9.5分,>9.5分脓毒症患者的预测正确率有90%,<9.5分时对非脓毒症患者的预测正确率有90%。

结论

本文提出的手术风险评分表可以较准确地预测手术风险,帮助外科医师采用有效的预防措施。

Objective

To design an assessment system to systematically analyze the risk of de-veloping post-operative sepsis and death of HIV-infected patients.

Methods

Eight hundred and fifty-one HIV-infected patients who underwent various surgical procedures from Jan 2008 to Jun 2015 in Shanghai Public Health Clinical Center were collected to conduct the retrospective statistical analysis. According the sepsis result, they were divided into two groups. Level of CD4, grade of incision, grade of surgery, opportunistic infections and organ function were scored from 1 to 4 corresponding to the serious-ness. The average score were used to calculate the sensitivity and specific value of the assessment system.

Results

Two hundred and sixty-four patients developed post-operative sepsis. The morbidity rate was 31.0%. Eleven died from serious sepsis in 30 days after surgery. The mortality rate was 1.3%. The average score of sepsis group was 11.50 while it was 7.46 in non-sepsis group. The score of sepsis group was significantly higher. When the cut-off value was set at 9.5, the sensitivity and specificity was 90%.

Conclusion

This assessment system can predict the surgery risk of HIV-infected patients and help surgeons to take preventive steps.

表1 HIV感染者手术风险评分表
图1 脓毒症、非脓毒症和脓毒症死亡3组患者的平均值与95% CI
表2 Logistics回归-以分类变量计算HIV感染各风险指标的结果
图2 基于风险评分加和的风险预测ROC评分
图3 脓毒症、非脓毒症和脓毒症死亡3组患者在各个分值的分布情况
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