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Risk-adjus.ment in hepatobiliarypancreatic surgery

World Journal of Gastroenterology 2005年第16期11卷 2450-2455页

作者： Hemant M Kocher Paris P Tekkis Palepu Gopal Ameet G Patel simon Cottam Irving s Benjamin Academic department of surgery King's College Hospital Denmark HillLondon SE5 9RYUK department of Anaesthesia King's College Hospital Denmark HillLondon SE5 9RYUK

AIM: The present study evaluates the performance of the POssUM, the American society of Anesthetists (AsA), APACHE and Childs classification in predicting mortality and morbidity in hepatopancreaticobiliary (HPB) surgery. We describe especially the limitations and advantages of risk in stratifying the patients. METHODs: We investigated 177 randomly chosen patients undergoing elective complex HPB surgery in a single institution with a total of 71 pre-operative and intra-operative risk factors. Primary endpoint was in-hospital mortality and morbidity. Ordered logistic regression analysis was us.d to identify individual predictors of operative morbidity and mortality. REsULTs: The operative mortality in the series was 3.95%. This compared well with the p-POssUM and APACHE predicted mortality of 4.31% and 4.29% respectively. Postoperative complications amounted to 45% with 24 (13.6%) patients having a major adverse event. On multrvariate analysis the pre-operative POssUM physiological score (OR = 1.18, P = 0.009) was superior in predicting complications compared to the AsA (P= 0.108), APACHE (P= 0.117) or Childs classification (P= 0.136). In addition, serum sodium, creatinine, international normalized ratio (INR), pulse rate, and intra-operative blood loss were independent risk factors. A combination of the POssUM variables and INR offered the optimal combination of risk factors for risk prognostication in HPB surgery. CONCLus.ON: Morbidity for elective HPB surgery can be accurately predicted and applied in everyday surgical practice as an adjunct in the process of informed consent and for effective allocation of resources for intensive and high-dependency care facilities.

关键词： Hepatobiliarypancreatic surgery Risk adjus.ment Operative mortality Operative morbidity Regression models

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有早产史婴幼儿的肺功能下降、RsV感染和呼吸系统疾病发病率的研究

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世界核心医学期刊文摘（儿科学分册） 2006年第5期2卷 7-8页

作者： Broughton s. Bhat R. Roberts A. A.Greenough 张振 department of Child Health King's College Hospital Denmark Hill London SE5 9RS United Kingdom.Prof.

Background: Diminished lung function appears to be a risk factor for respirato ry syncytial virus.(RsV) infection/bronchiolitis in term born infants. Aims: To determine if diminished lung function prior to neonatal unit discharge was assoc iated with subsequent symptomatic RsV lower respiratory tract infection (LRTI) a nd respiratory morbidity in prematurely born infants. Methods: Of 39 infants in a tertiary neonatal intensive care unit (median gestational age 28 weeks, range 23-31), 20 had bronchopulmonary dysplasia. Lung function (compliance and resist ance of the respiratory system(Crs and R rs) and functional residual capacity (F RC)) was measured on the neonatal unit at 36 weeks postmenstrual age (PMA). Foll owing neonatal unit discharge, nasopharyngeal aspirates were obtained on every o ccasion, at home or in hospital, an infant had an LRTI. RsV was identified by im munofluorescence and/or culture. Results: The 15 infants who suffered a symptoma tic RsV LRTI had a higher mean Rrs and suffered more wheeze at follow up than th e rest of the cohort. Regression analysis showed that a high Rrs was significant ly associated with a symptomatic RsV LRTI; significant factors for cough were a high Rrs and a symptomatic RsV LRTI, and for wheeze were a high Rrs. Conclus.on: Prematurely born infants, who had a symptomatic RsV LRTI and/or respiratory mor bidity at follow up, had worse lung function prior to neonatal unit discharge.

关键词：婴幼儿呼吸道合胞病毒 RsV感染疾病发病率呼吸系统肺功能早产新生儿重症监护室支气管肺发育不良下呼吸道感染

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