高龄非心脏手术患者围手术期死亡及危险因素分析  

Analysis of perioperative death and risk factors in senile patients undergoing non-cardiac surgery

作　　者：吴德华 施燕渲 王卫星 唐佳雯 朱涛 Wu Dehua;Shi Yanxuan;Wang Weixing;Tang Jiawen;Zhu Tao(Department of Anesthesiology,Songjiang Hospital(Preparation)Affiliated to Medical College of Shanghai Jiao Tong University,Shanghai,201600,P.R.China)

机构地区：[1]上海交通大学医学院附属松江医院(筹)麻醉科,上海201600

出　　处：《老年医学与保健》2023年第1期20-24,48,共6页Geriatrics & Health Care

基　　金：上海市医学重点专科建设项目(ZK2019C11)。

摘　　要：目的探讨高龄患者行非心脏手术围手术期死亡的危险因素。方法回顾性分析上海交通大学医学院附属松江医院2020年1月—2021年12月行非心脏手术的高龄患者临床资料。采用倾向评分匹配法匹配患者,根据围手术期是否死亡将患者分为死亡组(n=24)和非死亡组(n=72)。记录患者的术前、术中和术后情况,分析围手术期死亡的危险因素。结果死亡组与非死亡组美国麻醉医师协会(ASA)分级构成比差异有统计学意义(P<0.01)。与非死亡组比较,死亡组手术时间更长(P=0.034),出血量更多(P=0.001),术中最低收缩压(P=0.009)/舒张压(P=0.044)更低,平均动脉压<70 mmHg时间更长(P=0.049),术中最快心率更快(P=0.039)。且2组手术类型和麻醉方法构成比差异有统计学意义(P<0.05)。与非死亡组比较,死亡组入住重症监护室(ICU)更多,入住ICU时间更长,住院费用更高,术后并发症更多(P<0.01)。ASA分级(IV~V)和神经外科手术是高龄患者围手术期死亡的独立危险因素。结论神经外科手术和更高的ASA分级可能是高龄非心脏手术患者围手术期死亡的危险因素。Objective To explore the risk factors of perioperative death in senile patients undergoing non-cardiac surgery.Methods The clinical data of senile patients who underwent non-cardiac surgery from January 2020 to December 2021 in Songjiang Hospital Affiliated to Medical College of Shanghai Jiao Tong University were retrospectively analyzed.The patients were matched by the propensity score matching method and divided into death group(n=24)and non-death group(n=72)according to whether they died during the perioperative period.The preoperative,intraoperative and postoperative conditions of patients were recorded,and the risk factors of perioperative death were analyzed.Results There was statistically significant difference in the constituent ratio of the American Society of Anesthesiologists(ASA)classification between the death group and the non-death group(P<0.01).Compared with the non-death group,the operation time of the death group was longer(P=0.034),bleeding was more(P=0.001),intraoperative minimal systolic pressure(P=0.009)/diastolic pressure(P=0.044)were lower,cumulative time of mean arterial pressure<70 mmHg was longer(P=0.049),and intraoperative maximal heart rate was faster(P=0.039).There was statistically significant difference in the constituent ratio of operation type and anesthesia method between the two groups(P<0.05).Compared with the non-death group,the death group had more patients in intensive care unit(ICU),longer stay in ICU,higher hospitalization costs and more postoperative complications(P<0.01).ASA classification(IV~V)and neurosurgery were independent risk factors for perioperative death in senile patients.Conclusion Neurosurgery and higher ASA classification may be risk factors for perioperative death in senile patients undergoing non-cardiac surgery.

关 键 词：高龄老人 围手术期 死亡 危险因素 

分 类 号：R654.2[医药卫生—外科学]