普外科不同年龄老年住院手术患者手术安全性比较  

Surgical Safety of Elderly Hospitalized Patients Stratified by Age in General Surgery

作　　者：郭晓波 韩伟[1] 姜晶梅[1] 王子兴[1] 张璐雯 吴鹏[1] 于晓初[2] GUO Xiaobo;HAN Wei;JIANG Jingmei;WANG Zixing;ZHANG Luwen;WU Peng;YU Xiaochu(Department of Epidemiology and Biostatistics,Institute of Basic Medical Sciences,CAMS and PUMC,Beijing 100005,China;Department of Nephrology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院基础医学研究所,北京协和医学院基础学院流行病与卫生统计学系,北京100005 [2]中国医学科学院,北京协和医学院,北京协和医院肾内科,北京100730

出　　处：《中国医学科学院学报》2023年第4期549-555,共7页Acta Academiae Medicinae Sinicae

基　　金：国家卫生和计划生育委员会公益性行业科研专项(201402017)

摘　　要：目的比较普外科不同年龄组老年住院手术患者手术安全的差异性,为临床术前评估、治疗决策提供参考。方法从2015年1至6月和2016年1至6月开展的全国多中心调查项目中纳入≥60岁的普外科住院手术患者,描述患者特征及术后结局,探讨不同年龄组术后不良结局的风险因素。结果高龄老年(≥75岁)占17.33%,非高龄与高龄老年患者患有3种及以上的基础疾病(13.18%比5.36%)、急诊手术(16.64%比7.62%)、美国麻醉医师协会评分≥3(48.68%比27.28%)及术后重返ICU(33.64%比12.00%)差异均有统计学意义(P均<0.001)。在术后结局方面,非高龄与高龄老年患者术后感染类并发症差异无统计学意义(7.29%比6.40%,P=0.410),而严重并发症差异有统计学意义(6.51%比2.60%,P<0.001),并且急诊手术是非高龄与高龄老年患者不同术后结局共同的独立风险因素。结论高龄并不是手术的禁忌,根据患者身体状况、可利用手术资源等做好术前评估,老年患者依旧可以从中获益。Objective To compare the surgical safety of elderly hospitalized patients in different age groups undergoing general surgery,and provide references for preoperative evaluation and treatment decision-making.Methods The inpatients≥60 years old in the department of general surgery were selected from a national multi-center survey conducted from January to June in 2015 and from January to June in 2016.The patient characteristics and postoperative outcomes were described,and the risk factors for adverse postoperative outcomes of patients in different age groups were explored.Results The elderly patients(≥75 years old)accounted for 17.33%.The non-elderly patient(<75 years old)group and the elderly patient(≥75 years old)group had significant differences in the proportions of patients with three or more chronical diseases(13.18%vs.5.36%,P<0.001),emergency surgery(16.64%vs.7.62%,P<0.001),American Society of Anesthesiologists score≥3(48.68%vs.27.28%,P<0.001),and postoperative return to the intensive care unit(33.64%vs.12.00%,P<0.001).The occurrence of postoperative infectious complications showed no significant difference between the two age groups(7.29%vs.6.40%,P=0.410),while severe complications differed between the two groups(6.51%vs.2.60%,P<0.001).Besides,emergency surgery was a common independent risk factor for the two age groups.Conclusions Advanced age is not a contraindication to surgery of elderly patients.With consideration to patient’s physical conditions and available surgical resources,elderly patients can still benefit from surgery.

关 键 词：高龄老年 手术安全 普外科 手术并发症 

分 类 号：R619[医药卫生—外科学]