影响腰椎后路减压融合内固定术后住院时间的多因素分析  

Multiplefactor Analysis of Length of Stay Following Lumbar Spine Surgery

作　　者：郭伟俊[1,2] 蔡东岭[2] 陈晓峰[2] 马航展 许伟亮 Guo Weijun;Cai Dongling;Chen Xiaofen(Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Department of Orthopaedics,Panyu Hospital of Chinese Medicine,Guangzhou 511400,China)

机构地区：[1]广州中医药大学,广东广州510006 [2]广州市番禺区中医院骨科,广东广州511400

出　　处：《实用骨科杂志》2018年第3期193-196,288,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨影响腰椎后路融合减压内固定术后住院时间(length of stay,LOS)的危险因素,为临床缩短患者术后LOS提供依据及相应措施。方法回顾分析在2016年5月至2017年5月接受腰椎后路融合减压内固定术的226例患者的临床资料,记录性别、年龄、体重、吸烟史、喝酒史、婚姻状况、职业状况、术前美国麻醉师协会评分(American society of anesthesiologist,ASA)、术前合并病、手术时间、融合节段、术中减压方式、估计失血量、术中补液量、术中输血量、腰室引流管留置时间、引流量、术后输血量及术后显著事件等26个可能对LOS有影响的因素,按LOS≥16d(75th LOS)定义为超长住院,应用多元逐步回归分析上述因素与LOS的关系,探讨其中的原因及相应处理措施。结果正常LOS为15d(6~34d),超长LOS患者共60例(26.5%)。多元逐步回归结果表明年龄(β=0.051,P=0.010)、术中估计失血量(estimated blood loss,EBL)(β=0.002,P<0.001)及减压方式(β=-1.603,P<0.001)与腰椎后路融合减压内固定术后LOS存在显著独立线性关系。结论年龄、术中估计失血量、椎板减压方式是影响LOS独立危险因素,控制失血量及正确选择减压方式可有助于缩短LOS。Objective To identify predictors of length of stay(LOS)after lumbar spine surgery.Methods Retrospective analysis was made on the clinical data of patients who were underwent open,posterior lumbar instrumented fusion with decompression by the orthopedic spine service at one institution between May 2016 and May 2017.LOS was determined from the date of surgery to the date of discharge.Predictors of LOS were investigated with a multivariate stepwise regression model,including pre-surgery factors(patient demographics,American Society of Anesthesiologists score and major medical comorbidities including diabetes,hypertension,pulmonary disease,heart disease or renal insufficiency)and perioperative factors(estimated blood loss,blood transfusion,fluids administered,surgery time,the methods of decompression,number of levels fused,drainage duration,blood transfusion after surgery,postoperative drainage volume and complications).Results A total of 226 patients were identified.LOS ranged from 6 days to 34 days,with a median of 15 days.60(26.5%)patients were defined as the extended LOS group.Multivariate stepwise regression identified age(P=0.010),estimated blood loss(EBL)(P<0.001),and the methods of decompression(P<0.001)as significant predictors of extended LOS.Conclusion Age,estimated blood loss and the way of decompression in the surgery are the identified variables associating with LOS.Therefore,controlling blood loss during surgery and electing appropriate techniques of posterior decompression may be beneficial to shorten the length of hospital stay after surgery.

关 键 词：腰椎后路手术 术后住院时间 多元回归 年龄 估计失血量 减压方式 

分 类 号：R683.2[医药卫生—骨科学]