老年腹膜后肿瘤患者的麻醉管理要点与预后分析  

Key points of anesthesia management and influencing factors of postoperative complications in elderly patients with retroperitoneal tumors

作　　者：蔡俊刚 刘鲲鹏 姚兰 张华[3] 索利斌 王军 李红培 魏越 苗成利[2] 陈骏[4] 罗成华 Cai Jungang;Liu Kunpeng;Yao Lan;Zhang Hua;Suo Libin;Wang Jun;Li Hongpei;Wei Yue;Miao chengli;Chen Jun;Luo Chenghua(Department of Anesthesiology,Peking University International Hosptial,Beijing 102206,China;Department of Retroperitoneal Tumor Surgery,Peking University International Hosptial,Beijing 102206,China;Clinical Epidemiology Research Center,Peking University Third Hospital,Beijing 100191,China;Department of Retroperitoneal Tumor Surgery,Peking University People’s Hosptial,Beijing 100044,China)

机构地区：[1]北京大学国际医院麻醉科,北京102206 [2]北京大学国际医院腹膜后肿瘤外科,北京102206 [3]北京大学第三医院临床流行病学研究中心,北京100191 [4]北京大学人民医院腹膜后肿瘤外科,北京100044

出　　处：《中华临床医师杂志(电子版)》2024年第10期881-887,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京大学国际医院院内重点课题(YN2023ZD04)

摘　　要：目的总结并分析老年患者腹膜后肿瘤切除术的麻醉管理要点及对患者预后的影响,为此类患者的围术期管理提供参考。方法回顾自2015年1月至2022年12月收治于北京大学国际医院、在全身麻醉下实施腹膜后肿瘤切除术、年龄≥65岁的老年患者麻醉管理情况,并对住院总时长、术后住院时长和术后并发症的影响因素进行分析。结果共计248例患者纳入本研究,男性136例,女性112例,平均年龄(69.7±4.4)岁,术前ASA分级Ⅱ级134例,III级106例,IV级8例。接受≥2次手术患者129例(52.0%),手术和麻醉时长分别为(287.2±132.0)min和(362.9±135.9)min。术中采用目标导向液体治疗方案,根据输血指征补充血制品。术毕198例(79.8%)患者拔管回病房,50例(20.2%)患者入ICU继续治疗。患者的住院总时长(38.0±21.9)d,术后住院时长(26.5±20.7)d,多重线性回归分析显示住院总时长和术后住院时长与术中应用凝血酶原复合物及术毕血糖水平呈正相关。术后出现严重并发症(Clavien-Dindo分级≥3a)44例,logistic回归分析显示男性、术中输注人工胶体液、术毕乳酸水平是术后严重并发症的独立危险因素;死亡4例,死亡原因为感染中毒性休克、失血性休克和多器官功能衰竭。结论老年患者行腹膜后肿瘤切除手术需要完善的术前准备和更加精准的麻醉管理,术中避免输注人工胶体液,谨慎输注凝血酶原复合物,重点关注男性患者、术毕血糖和乳酸水平,围术期针对性处理有助于改善患者预后。Objective To summarize and analyze the key points of anesthesia management for elderly patients undergoing retroperitoneal tumor resection and its impact on patient prognosis,with an aim to provide reference for perioperative management of such patients.Methods This study retrospectively analyzed the anesthesia management of elderly patients(aged≥65 years)who underwent retroperitoneal tumor resection under general anesthesia at Peking University International Hospital from January 2015 to December 2022,and identified the influencing factors of total length of stay,postoperative hospitalization duration,and postoperative complication classification.Results A total of 248 patients were included in this study,including 136 males and 112 females with an average age of(69.7±4.4)years.Preoperative ASA classification was 134 cases of grade II,106 cases of grade III,and 8 cases of grade IV.One hundred and twenty-nine patients(52.0%)had two or more surgeries,with the duration of surgery and anesthesia being(287.2±132.0)minutes and(362.9±135.9)minutes,respectively.Goal-directed fluid therapy was used during surgery,and blood products were supplemented according to the indications for blood transfusion.After surgery,198 patients(79.8%)were extubated and returned to ordinary ward,while 50 patients(20.2%)were admitted to the intensive care unit for further treatment.The mean total length of stay was(38.0±21.9)days,and the mean length of postoperative hospitalization was(26.5±20.7)days.Multiple linear regression analysis showed that the length of hospitalization and postoperative hospitalization were positively correlated with the use of prothrombin complex concentrate during surgery and the level of blood glucose at the end of surgery.There were 44 cases of severe complications(Clavien-Dindo grade≥3a)after surgery,Logistic regression analysis showed that male gender,intraoperative infusion of artificial colloid solution,and postoperative lactate level were independent risk factors for severe postoperative complicatio

关 键 词：老年 腹膜后肿瘤 麻醉管理 预后 

分 类 号：R614[医药卫生—麻醉学]