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目的:探讨早期改良预警评分(MEWS)对急性重症胆管炎(ACST)患者手术类型选择中的价值。方法:回顾性分析187例ACST手术病例资料,分别比较不同MEWS分数段患者中控制性手术与确定性手术组并发症发生率、死亡率的差异。结果:MEWS评分不同分数段病人总的并发症发生率与死亡率比较(并发症发生率:0~4分组3.21%,5~9分组8.02%,≥10分组14.97%;死亡率分别为:0、1.60%、6.95%)差异均有显著性差异(P<0.05)。MEWS分0~4分段不同手术方式病人并发症发生率(1.52%VS4.13%)、死亡率(均为0)比较均无显著性差异;5~9分段并发症发生率(6.06%VS9.09%)有显著性差异(P<0.05),死亡率(1.52%VS1.65%)无显著性差异;≥10分段并发症发生率(9.09%VS18.18%)和死亡率(4.55%VS8.26%)均有显著性差异(P<0.05)。结论:MEWS评分可用于评价ACST病人术前、术后的病情,预测其手术并发症及死亡危险性;可用于指导手术类型的选择。
Objective: To explore the value of early modified warning score (MEWS) in the selection of operative type in patients with acute severe cholangitis (ACST). Methods: The data of 187 ACST cases were retrospectively analyzed. The differences of morbidity and mortality between controlled operation and definite operation group were compared among patients with different MEWS scores. Results: The complication rates of patients with different MEWS scores were compared with those of the patients with the same morbidity (complication rate: 3.21% in 0-4 group, 8.02% in 5-9 group and 14.97% in ≥10 group; mortality rate was 0 , 1.60% and 6.95% respectively) (P <0.05). There was no significant difference in the incidence of complications (1.52% VS4.13%) and mortality (all 0) between MEWS and 0 ~ 4 in different operation modes. The incidence of complications in 5 ~ 9 segments was 6.06% VS9.09%), there was no significant difference in mortality (1.52% VS1.65%); the incidence of ≥10 segmental complication (9.09% VS18.18%) and mortality ( 4.55% vs 8.26%) (P <0.05). Conclusion: The MEWS score can be used to evaluate the preoperative and postoperative ACST patients, predict the complications and death risk; can be used to guide the choice of surgical types.