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老年患者手术风险:危险因素的前瞻性评估

[Risk of surgery in geriatric age: prospective evaluation of risk factors].

作者信息

Leardi S, De Santis C, Ciccarelli O, Valenti M, D'Alessandro A, Pietroletti R, Simi M

机构信息

Cattedra di Chirurgia Generale II, Università degli Studi di L'Aquila.

出版信息

Ann Ital Chir. 1998 Sep-Oct;69(5):575-9.

Abstract

The use of Risk Index in surgery is aimed to plan surgical strategy in order to achieve a better post-operative prognosis. This is especially true in geriatric surgery where ASA Index and, more recently, Reiss Index are widely employed. Since the mentionated Risk Indices are calculated on the basis of different factors, in this prospective study we compared the two Risk Indices with the aim of verify which index offers better prognostic indications. 125 consecutive patients, aged older 70 years, undergoing surgical treatment, were investigated. The patients were grouped according to ASA Index and Reiss Index and postoperative morbidity and mortality rate was calculated. Both Indices resulted good predictive for the postoperative prognosis (ASA: G Statistic = 31.531, p < 0.001; Reiss: G Statistic = 18.416, p < 0.001), but ASA Index sensitivity was better (Specificity = 100%, sensitivity = 28%, false negative rate = 72%) than Reiss Index (Specificity = 100%, sensitivity = 0, false negative rate = 100%). Therefore ASA Index has clinical valid role in valuing surgical risk in elderly.

摘要

手术中使用风险指数旨在规划手术策略,以实现更好的术后预后。这在老年手术中尤为如此,其中美国麻醉医师协会(ASA)指数以及最近的赖斯指数被广泛应用。由于上述风险指数是基于不同因素计算得出的,在这项前瞻性研究中,我们比较了这两种风险指数,目的是验证哪种指数能提供更好的预后指标。对125例连续接受手术治疗的70岁以上患者进行了调查。根据ASA指数和赖斯指数对患者进行分组,并计算术后发病率和死亡率。两种指数对术后预后均有良好的预测性(ASA:G统计量=31.531,p<0.001;赖斯:G统计量=18.416,p<0.001),但ASA指数的敏感性更好(特异性=100%,敏感性=28%,假阴性率=72%),优于赖斯指数(特异性=100%,敏感性=0,假阴性率=100%)。因此,ASA指数在评估老年患者手术风险方面具有临床有效作用。

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