80岁以上高龄非心脏手术患者围术期并发症和危险因素分析  

Analysis of perioperative complications and risk factors for elderly patients over 80 years old with non-cardiac surgery

作　　者：吴德华 王卫星 施燕渲 唐佳雯 朱涛 WU Dehua;WANG Weixing;SHI Yanxuan;TANG Jiawen;ZHU Tao(Department of Anesthesiology,Shanghai Songjiang District Central Hospital—Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201600,China)

机构地区：[1]上海市松江区中心医院/上海交通大学医学院附属松江医院〔筹〕麻醉科,上海201600

出　　处：《右江医学》2023年第7期615-622,共8页Chinese Youjiang Medical Journal

基　　金：上海市医学重点专科建设项目(ZK2019C11)。

摘　　要：目的探讨80岁以上高龄非心脏手术患者围术期并发症和危险因素。方法回顾性分析上海市松江区中心医院2020年1月至2021年12月80岁以上行非心脏手术的高龄患者828例。记录患者术前数据、术中血流动力学指标、手术时间、术中出血量、入ICU情况、ICU停留时间、住院时间、住院费用、围术期并发症和死亡情况。单因素和多因素分析术后并发症增加的危险因素。结果术后并发症发生率为13.4%(111/828)。与术后无并发症患者比较,术后有并发症的患者术中经历了更长时间的低血压(P<0.01或0.05),术中出血量更多(P<0.001),术后入ICU比例更高(P<0.001),ICU停留时间更长(P<0.001),住院时间更长(P<0.001),住院费用更高(P<0.001),术后死亡率更高(P<0.001)。术后并发症增加的独立危险因素包括长时间手术、术前肾功能不全、术前肝功能不全和更高的ASA分级。结论80岁及以上的高龄患者术后并发症发生率较高。高龄患者术后并发症增加的危险因素包括更长的手术时间、术前肾功能不全、术前肝功能不全和更高的ASA分级。这些发现有助于针对高龄患者加强围术期管理,降低围术期并发症发生率和病死率。Objective To explore perioperative complications and risk factors for elderly patients over 80 years old with non-cardiac surgery.Methods Retrospective analysis was carried out on 828 patients over 80 years old who underwent non-cardiac surgery between January 2020 and December 2021 at Shanghai Songjiang District Central Hospital.Preoperative data,episodes of intraoperative hemodynamical change,operation duration,blood loss,postoperative ICU admission,ICU stay,length of hospital stay,cost of hospitalization,perioperative complications and perioperative death were recorded and analyzed.Univariate and multivariate analyses were performed to identify risk factors for postoperative complications.Results The incidence of postoperative complications was 13.4%(111/828).Comparing to patients without postoperative complications,patients with postoperative complications experienced longer time of hypotension(P<0.01 or 0.05),more blood loss(P<0.001),higher rate of ICU admission(P<0.001),longer time of ICU stay(P<0.001),longer length of hospital stay(P<0.001),higher cost of hospitalization(P<0.001),and higher rate of postoperative death(P<0.001).Independent risk factors for increasing postoperative complications included prolonged surgery,preoperative renal dysfunction,preoperative liver dysfunction,and higher ASA grading.Conclusion The incidence of postoperative complications is high in elderly patients aged 80 and above.The risk factors for increasing postoperative complications in elderly patients include longer surgical time,preoperative renal dysfunction,preoperative liver dysfunction,and higher ASA grading.These findings help to strengthen perioperative management for elderly patients,and reduce the incidence of perioperative complications and mortality.

关 键 词：高龄 非心脏手术 围术期 并发症 

分 类 号：R65[医药卫生—外科学]