APACHEⅡ及MODS評分與腫瘤術后患者預后的相關性研究

王成連　藍小林　葉永強　羅忠兵　曾國興

【摘要】 目的：探究APACHEⅡ評分結合多器官功能不全（MODS）評分系統對食管癌術后患者死亡預后的預測價值。方法：收集預試驗期和2014年7月-2015年12月于本院進行食管癌開胸切除手術的80例患者的臨床資料，按術后住院期間是否死亡分為死亡組和存活組；兩組患者均于食管癌開胸手術術后入住ICU，進行MODS評分，且于入住后第1、3、5天分別進行APACHEⅡ評分；運用多變量COX比例風險模型分析MODS評分分值對死亡預后的預測價值，并且分析腫瘤術后MODS的發生與APACHEⅡ評分及MODS評分的相關性。結果：食管癌術后患者APACHEⅡ評分高低與患者預后存在相關性，APACHEⅡ評分分值越高，腫瘤術后患者的病情越重；并且，隨著MODS評分增加，患者病死率增加；但是，APACHEⅡ評分預測病死率的準確性受MODS的影響較大，使得低分區預測值顯著高于實際值，高峰期預測值顯著低于實際值；多因素COX比例風險模型分析提示食管癌術后患者的預后指數為：PI=1.679×并發MODS+0.854×APACHEⅡ評分+1.079×MODS評分。結論：應用APACHEⅡ及MODS評分綜合評估系統對腫瘤手術后患者的預后評估，可以使腫瘤手術后患者的預后評估更加具有可靠性和準確性。

【關鍵詞】 APACHEⅡ評分； MODS評分； 食管癌術后； 病死率； 多因素COX回歸

Correlation between APACHEⅡ and MODS Score and Prognosis of Patients after Tumor Resection/WANG Chenglian，LAN Xiaolin，Ye Yongqiang，et al.//Medical Innovation of China，2017，14（32）：057-060

【Abstract】 Objective：To explore the prognostic value of APACHE Ⅱ scoring system combined with MODS scoring system in the prognosis of esophageal cancer patients after operation.Method：Clinical data of 80 patients who underwent preoperative trial from July 2014 to December 2015 for esophagectomy of thoracotomy in our hospital，according to postoperative death during hospitalization they were divided into death group and survival group.Patients of two groups were in thoracic esophageal cancer after surgery in ICU，MODS score on the first，third，fifth day APACHE score were given.Using multivariate COX proportional hazard model analyzed the value of MODS score in predicting the prognosis of death，the correlation of MODS and APACHE score and MODS score after tumor resection were analyzed.Result：The postoperative esophageal cancer patients APACHEⅡ score correlated with prognosis，APACHEⅡ score was higher，postoperative tumor patients with more serious illness.With the increase of MODS score，mortality increased.However，the accuracy of APACHEⅡ score in predicting mortality was seriously affected by MODS，the low partition prediction value was significantly higher than the actual value and predictive value of the peak was significantly lower than the actual value.COX multivariate analysis suggested that postoperative esophageal cancer prognosis index was PI=1.679×MODS+0.854×APACHEⅡ score+1.079×MODS score.Conclusion：The application of APACHE Ⅱ and MODS scoring system to evaluate the prognosis of patients after tumor operation can make the prognosis evaluation more reliable and accurate.

【Key words】 APACHE Ⅱ score； MODS score； Postoperative esophageal cancer； Fatality rate； Multivariate COX regressionendprint

First-authors address：Ganzhou Tumor Hospital，Ganzhou 341000，China

doi：10.3969/j.issn.1674-4985.2017.32.014

食管癌是危害人類健康的常見惡性腫瘤之一，近年來其發病率在世界范圍內逐年上升。外科手術是食管癌早期根治性治療的首先方案，然而其手術范圍廣、難度高、時間長，因此術后易發多種并發癥[1-2]。因此，對食管癌術后患者死亡預后的評估預測是進行術后早期治療、降低病死率的有效手段之一。……