高龄患者术后严重并发症的危险因素分析  

Risk factors of severe complications after surgery in elderly patients

作　　者：吴松 胡宪文[1] WU Song;HU Xianwen(Department of Anesthesiology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院麻醉科,合肥市230601

出　　处：《临床麻醉学杂志》2023年第10期1045-1049,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨高龄患者择期手术后严重并发症的危险因素。方法选择行骨科、妇科、胃肠外科手术的患者332例,男123例,女209例,年龄≥80岁。根据患者是否发生术后严重并发症分为两组:严重并发症组和对照组。记录一般情况、术前合并症、实验室检查、手术和麻醉情况。采用多因素Logistic回归分析术后发生严重并发症的危险因素。结果有43例(13.0%)患者发生术后严重并发症。与对照组比较,严重并发症组BMI和术中最低MAP值明显降低,ASA分级、改良Goldman分级、合并控制不良糖尿病比例明显升高,手术开始时间明显延迟(P<0.05)。Logistic回归分析结果显示,术后严重并发症的危险因素为BMI降低(OR=1.145,95%CI 1.042~1.261,P=0.016)、ASA分级升高(OR=3.587,95%CI 1.210~10.632,P=0.021)、改良Goldman分级升高(OR=7.175,95%CI 2.355~21.861,P=0.001)、控制不良的糖尿病(OR=2.202,95%CI 1.041~4.657,P=0.039)、手术开始时间延迟(OR=2.611,95%CI 1.242~5.491,P=0.011)和术中最低MAP值降低(OR=1.068,95%CI 1.116~1.119,P=0.009)。结论高龄患者择期手术后严重并发症发生的独立危险因素为BMI降低、ASA分级和改良Goldman分级升高、控制不良的糖尿病、手术开始时间延迟、术中最低MAP值降低。Objective To assess the risk factors of postoperative serious complications in over-aged patients.Methods A total of 332 patients,123 males and 209 females,aged≥80 years who received orthopedics,gynecology and gastrointestinal surgery were selected.Patients were divided into severe complication group and control group according to whether serious complications occurred.Demographics,comorbidities,preoperative laboratory tests,characteristics of operation and anesthesia.Multivariate logistic regression analysis was performed to analyze the risk factors for serious postoperative complications in this population.Results Serious postoperative complications occurred in 43 patients(13.0%).Compared with the control group,the BMI and the minimum MAP value during the operation in the severe complications group were significantly reduced,the ASA physical status,the modified Goldman rating,the proportion of combined poorly controlled diabetes,the ICU occupancy rate and the total cost of hospitalization were significantly increased,the start time of surgery was significantly delayed(P<0.05).The results of binary Logistic regression analysis showed that the independent factors of serious postoperative complications in this population were BMI decreased(OR=1.145,95%CI 1.042-1.261,P=0.016),ASA physical status increased(OR=3.587,95%CI 1.210-10.632,P=0.021),Goldman improved(OR=7.175,95%CI 2.355-21.861,P=0.001),the proportion of poorly controlled diabetes was increased(OR=2.202,95%CI 1.041-4.657,P=0.039),and the start time of surgery was delayed(OR=2.611,95%CI 1.242-5.491,P=0.011)and the minimum intraoperative MAP value decreased(OR=1.068,95%CI 1.116-1.119,P=0.009).Conclusion Independent predictors of severe postoperative complications in patients over 80 years old include:low BMI,high ASA grade,high modified Goldman classification,poorly controlled diabetes,delayed start of surgery,and low intraoperative minimum MAP.

关 键 词：高龄 术后并发症 危险因素 

分 类 号：R614[医药卫生—麻醉学]