胃肠手术患者围手术期电解质失衡999例临床分析  

Clinical analysis of perioperative electrolyte imbalance in 999 patients undergoing gastrointestinal surgery

作　　者：王凯[1] 张南荣[1] 邓德明 邱雅丽 林映珊 靳三庆[1] Wang Kai;Zhang Nanrong;Deng Deming;Qiu Yali;Lin Yingshan;Jin Sanqing(Department of Anesthesia,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院麻醉科,广州510655

出　　处：《中华胃肠外科杂志》2018年第12期1427-1432,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省省级科技计划项目(2013802200000005).

摘　　要：目的探讨胃肠手术患者围手术期电解质失衡情况。方法采用回顾性病例分析的方法,经电子病历系统收集中山大学附属第六医院2018年1-4月全身麻醉下行胃肠手术、且手术期间进行血气分析监测的患者,排除术中液体入量过多、病情危重的抢救患者及入组其他临床试验的患者,共999例患者纳入分析。分别采用术前最后一次的生化检查、麻醉后1h内的第一次血气分析及术后24h内第一次生化检查的数据来记录患者术前、术中、术后的血钠、血钾、血钙情况。分析电解质失衡情况,并采用Logistic回归分析筛查相关影响因素。结果全组999例行胃肠手术患者中男性638例(63.9%),女性361例(36.1%),年龄(56.9±14.6)岁,行急诊手术58例(5.8%),择期手术941例(94.2%),术前使用泻药次数≥3次者62例,术前灌肠次数≥3次者115例。全组患者术中低钾血症发生率为49.6%(496/999),术后降至15.2%(152/999),未发现高钾血症病例。术中低钙血症发生率为53.8%(537/999),术后升至79.7%(796/999)。肠梗阻患者术前低钾血症的发生率33.3%(17/51),高于肠癌12.3%(86/703)、胃癌7.8%(8/104)及其他胃肠疾病10.6%(15/141),差异均有统计学意义(均P<0.05);同样,肠梗阻患者术前和术中低钠血症发生率均为15.7%(8/51),高于肠癌[3.0%(21/703)和2.3%(16/703)]和胃癌[2.9%(3/104)和1.9%(2/104)];肠梗阻患者术前低钙血症发生率为31.4%(16/51),也高于肠癌[7.4%(52/703)]和胃癌[8.7%(9/104)],差异均有统计学意义(均P<0.05)。Logistic回归分析显示,肠梗阻和急诊手术是患者术前电解质失衡的危险因素(均P<0.05);术前电解质失衡是术中电解质失衡的危险因素(均P<0.05);而术中电解质失衡是术后电解质失衡的危险因素(均P<0.05);术前电解质失衡是术后血钠和血钾失衡的危险因素(均P<0.05)。结论胃肠手术患者围手术期出现电解质失衡的发生率较高,以低钙血症及低钾血症为主,需及时识别电Objective To investigate the perioperative electrolyte imbalance in patients undergoing gastrointestinal surgery. Methods Retrospective case analysis was used in this study. Patients who underwent gastrointestinal surgery under general anesthesia at the Sixth Affiliated Hospital of Sun Yat-sen University from January to April 2018 were selected through electronic medical records system. Blood gas analysis during surgery must be carried out in the enrolled patients. Patients with excessive fluid infusion, critical conditions or patients who had been enrolled in other clinical trials were excluded. A total of 999 patients were enrolled. The preoperative, intraoperative and postoperative concentrations of serum sodium, potassium and calcium were collected by the last biochemical examination before surgery, arterial blood gas analysis within 1 h after anesthesia and another biochemical examination within 24 hours after surgery respectively. The type and incidence of electrolyte imbalance were then analyzed, and logistic regression analysis was used to investigate the risk factors. Results In the 999 patients, 683 cases were male (63.9%) and 361 cases were female(36.1%), with an average age of (56.9±14.6) years old. Fifty-eight patients (5.8%) underwent emergency surgery and 941 patients (94.2%) underwent elective surgery; Sixty-two patients were treated with laxatives at least 3 times and 115 patients were treated with enema at least 3 times before operation. The incidence of hypokalemia was 49.6%(496/999) intraoperatively and decreased to 15.2%(152/999) postoperatively. No hyperkalemia cases were found. The incidence of hypocalcemia was 53.8%(537/999) intraoperatively and increased to 79.7% (796/999) postoperatively. The incidence of hypokalemia in ileus patients was 33.3%(17/51) before surgery, which was higher than that in patients with colorectal cancer [12.3%(86/703)], patients with gastric cancer [7.8%(8/104)] and patients with other gastrointestinal diseases [10.6%(15/141)] (all P<0.05). Similarly, the preope

关 键 词：胃肠手术 电解质失衡 钠 钾 钙 

分 类 号：R614[医药卫生—麻醉学]