傳統與新近思維（POSSUM指標）之外科加護病人嚴重度指標

Traditional and Developing Concepts (the POSSUM Score) of Disease Severity Index of Patients in Surgical Intensive Care Units

外科手術後病人加護照顧必要性的考量非僅限於本身疾病嚴重度，同時也與外科手術的侵襲程度有關。故在外科手術後病人入住加護病房與否的考量上，僅使用過去傳統的APACHE-II 去評估是不夠的。在沒有評估手術本身可能造成的風險上，常會有低估外科病人的狀況。同時，APACHE-II 也未考量外科手術病人在預期加護病房照顧所衍生的快速恢復與減少風險（包括健康與法律）考量。故一種同時考量疾病與手術嚴重度的尺標-波森指標計分（POSSUM score）將可預期對於外科手術後病人風險程度，以及入住加護病房必要性提供更客觀與接近事實的資訊。展望未來，這項指標應可配合傳統APACHE 指標協同評估手術後病人，提供術後風險與入住加護病房必要性更多有價值的資訊與參考。

Requirements of intensive care for surgical patients should not only consider patient disease severity, but also the intensity of interventions (the operative procedures). Traditional scoring systems, such as APACHE-II, which consider disease severity only, have the tendency to under estimate the necessity of intensive care for patients undergoing surgical or other invasive procedures (such as cardiac catheterization or endoscopic procedures). In addition, using APACHE-II only as criteria for admission to intensive care units for surgical patients would neglect the issue of benefit (rapid recovery) or risk (impact of sudden death) of these patients. Thus, the POSSUM score, a newly developed scoring system which includes the disease severity and operation intensity, theoretically can more accurately reflect the necessity of intensive care for surgical patients than traditional APACHE-II score. In this paper, the structure and application of POSSUM are briefly described. We think that POSSUM should be used along with traditional scoring systems to evaluate the necessity of intensive care for surgical patients.