~Teachingcenter的醫學筆記~

Boey score
= 主要以三個危險因子來預測病人的致死率。
--1.潰瘍穿孔持續＞24小時。
--2.術前休克(SBP＜100mmHg)
--3.合併嚴重疾病(如：嚴重的心臟病、肺部疾病、腎臟衰竭、糖尿病、肝臟衰竭)
= 以上三項，一項為1分，最高3分，最低0分

(Morbidity and Mortality) Adapted from: Varut Lohsiriwat, Siriluck Prapasrivorakul, et al. Perforated peptic ulcer: clinical presentation, surgical outcomes, and the accuracy of the Boey scoring system in predicting postoperative morbidity and mortality. World J Surg. 2009 Jan;33(1):80-5
(Conversion)參考自台灣部分醫學中心的統計資料，Boey 0的conversion rate應該有被高估，待更多嚴謹的研究資料以做修正

腹腔鏡手術和胃潰瘍穿孔
= 腹腔鏡對於潰瘍穿孔，可以同時提供確切的診斷和治療，但並非所有消化性潰瘍穿孔的病人都適合做腹腔鏡修補術，所以在術前解釋時，務必提及從腹腔鏡手術轉為傳統開腹手術的可能，以避免和病人或家屬產生衝突
= 以下幾個術前即可知道的情形，多半不適合腹腔鏡手術
--- Boey score 2以上
--- 年齡大於70歲
--- 發作(穿孔)時間超過一天
--- 破洞大於1公分
--- 生命徵象不穩定
= 而手術中也會因為潰瘍穿孔的位置難以到達、術中才發現的破洞過大、潰瘍邊緣組織脆弱、嚴重腹腔內污染等狀況，須轉換成傳統剖腹術式

Peptic Ulcer Perforation (PULP) score
= PULP評分系統包含以下幾個項目(最低0分，最高18分)

= 休克的定義(Shock on admission)
--- blood pressure < 100 mmHg and heart rate > 100 beats per min
= PULP評分最低0分，最高18分，以評估手術死亡率
--- 0~7分為低風險Low risk (< 25%
--- 8~18分為高風險High risk (> 25%)
Adapted from Noppawan Nichakankitti, Jadsada Athigakunagorn, et al. The accuracy of prognostic scoring systems for post-operative morbidity and mortality in patients with perforated peptic ulcer. International Surgery Journal. 2016 Feb;3(1):286-290

ASA Score
= Class 1: Normal Healthy Individual
= Class 2: Mild systemic disease with no functional limitation
= Class 3: Patient has severe systemic disease that is not incapacitating
= Class 4: Patient has incapacitating disease that is constant threat to life
= Class 5: A Moribund patient who is not expected to live 24 hour with or without surgery
= Class 6: A brain dead patient

消化性潰瘍穿孔手術的併發症：
= 肺炎(pneumonia) 3.6~30%
= 傷口感染(wound infection) 10~17%
= 泌尿道感染(urinary tract infection) 1.4~15%
= 吻合處滲漏(anastomosis leakage) 2~16%
= 腹內膿瘍(intra-abdominal abscess) 0~9%
= 腸阻塞(ileus) 2~4%
= 廔管(fistula) 0.5~4%
= 傷口癒合不全(wound dehiscence) 2.5~6%
= 出血(hemorrhage) 0.6%
= 再次手術(re-operation) 2~9%
= 敗血症(sepsis) 2.5%
= 死亡(mortality) 5~11%