外科手术患者术后出血现况及危险因素研究  

Status and risk factors of postoperative hemorrhage in patients undergoing surgery

作　　者：吴哓哓 张慧敏[4] 荀林娟 陈静娟[3] 宋瑞梅[2] 赵庆 刘贤亮[1] 杨开阳 施雁[1] WuXiaoxiao; Zhang Huimin; Xun Linjuan; Chen Jingjuan; Song Ruimei; Zhao Qing; Liu Xianliang; Yang Kaiyang; Shi Yan Nursing(Department, the 10th People＇s Hospital of Tongji University, Shanghai 200072, China ; Nursing Faculty, Nanchang University, Nanchang 330031, China ; Hepatobiliary Pancreatic Surgical Department, the lOth People＇s Hospital of Tongji University, Shanghai 200072, China ; Gastrointestinal SurgicalDepartment, the lOth People＇s Hospital of Tongfi University, Shanghai 200072, China)

机构地区：[1]同济大学附属第十人民医院护理部,上海200072 [2]同济大学附属第十人民医院肝胆胰腺外科,上海200072 [3]同济大学附属第十人民医院胃肠外科,上海200072 [4]南昌大学护理系,330031

出　　处：《中华现代护理杂志》2018年第27期3252-3258,共7页Chinese Journal of Modern Nursing

基　　金：上海市2016年度“科技创新行动计划”医学领域项目指南（16411951600）

摘　　要：目的探讨外科术后出血的发生率及相关影响因素，为预防其发生及制定合理的风险评估工具提供数据支持。方法回顾分析上海市某三级甲等医院2016年1-12月外科手术发生术后出血的50例患者临床资料，以1：2配比进行病例对照研究，进行单因素与多因素回归分析，探索外科手术患者发生术后出血的危险因素。结果全院外科（排除妇产科、五官科）手术量为18942例，发生术后出血50例，其中6例死亡，全院术后出血发生率为0．26％，出血患者的病死率为12％。术后出血发生率前4位科室分别为：胃肠外科（13例）、肝胆胰外科（11例）、心脏外科（10例）、神经外科（9例）。病例组与对照组经单因素及二元Logistic统计分析显示，术后白蛋白〈35g／L、术后AST异常、术后ALT异常、术后高血压是影响外科术后出血的独立危险因素。结论本中心外科术后出血的发生率较低，但病死率相对较高，医护人员应重点关注胃肠、肝脏、胰腺、心脏、脑部手术患者，且需增加对术后患者的血压和白蛋白以及肝功能的重视与密切观察，建立预防出血的评估，对于预防发生术后出血具有一定的预警作用。Objective To investigate the incidence and related factors of postoperative hemorrhage, so as to provide data support for preventing its occurrence and developing reasonable risk assessment tools. Methods The retrospective analysis of clinical data of 50 patients with postoperative hemorrhage after surgical operation in a 3A hospital in Shanghai from January to December 2016 was conducted. A 1 ： 2 matching casecontrol study was conducted to explore the risk factors of postoperative bleeding in surgical patients by univariate and multivariate regression analysis. Results The total number of surgical operations （excluding obstetrics and gynecology, five senses）was 18 942. Postoperative hemorrhage occurred in 50 cases, including 6 deaths. The incidence of postoperative hemorrhage was 0.26% and the mortality rate was 12%. The incidence of postoperative bleeding in the top four departments were gastrointestinal surgery （13 cases）, hepatobiliary and pancreatic surgery （11 cases）, cardiac surgery （10 cases）, nenrosurgery （9 cases）. The statistical analysis of binary Logistic in the case group and the control group showed that postoperative albumin 〈 35g/L, postoperative AST abnormality, postoperative ALT abnormality, postoperative hypertension were independent risk factors of postoperative bleeding. Conclusions The incidence of postoperative bleeding in this hospital is relativelylow, but the mortality is relatively high. Medical staff should pay more attention to the patients undergoing gastrointestinal, liver, pancreas, heart and brain surgery. It is also necessary to pay more attention to the blood pressure, albumin and liver function of the patients after operation, and establish the evaluation of prevention of hemorrhage, which has a certain early warning effect on the prevention of postoperative hemorrhage.

关 键 词：术后出血 出血率 危险因素 风险评估 

分 类 号：R473.6[医药卫生—护理学]