老年患者胃肠道手术后综合并发症的危险因素——一项多中心观察性研究  

Risk factors for overall postoperative complications in elderly patients undergoing gastrointestinal surgeries:a multicenter observational study

作　　者：吕雪彩 刘艳红[1,2,3] 韩诗怡 张浩赟 侯爱生 周志康 史立凯 高洁 曹江北[1] 张宏[1,2] 米卫东[1,2,3] LÜXuecai;LIU Yanhong;HAN Shiyi;ZHANG Haoyun;HOU Aisheng;ZHOU Zhikang;SHI Likai;GAO Jie;CAO Jiangbei;ZHANG Hong;MI Weidong(Department of Anesthesiology,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Chinese PLA Medical School,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心麻醉科,北京100853 [2]解放军医学院,北京100853 [3]解放军总医院老年病临床医学研究中心,北京100853

出　　处：《南方医科大学学报》2025年第4期736-743,共8页Journal of Southern Medical University

基　　金：国家重点研发计划(2018YFC2001900)。

摘　　要：目的探讨老年患者胃肠道手术后综合并发症的危险因素。方法纳入2020年4月~2022年4月全国17个中心1388例行择期胃肠道手术的老年患者。主要结局指标是术后30 d内综合并发症发生率,包括手术相关并发症、中枢神经精神系统、呼吸系统、心血管系统、消化系统并发症以及急性肾损伤。根据是否发生至少1种并发症将患者分为并发症组和无并发症组。比较两组患者基线资料,术前功能状态,术中麻醉和手术因素,用药情况、是否使用神经阻滞及术后镇痛等参数,采用单因素和多因素Logistic回归分析术后并发症的独立危险因素,并探讨术后急性疼痛与各系统并发症的相关性。结果老年患者胃肠手术后综合并发症发生率为50.8%(705/1388)。多因素分析显示,年龄[OR(95%CI):1.026(1.006~1.046)]、预后营养指数[OR(95%CI):0.998(0.997~1.000)]、术前生活质量评分[OR(95%CI):0.094(0.018~0.500)]、失血量[OR(95%CI):1.002(1.001~1.003)]以及术后急性疼痛[OR(95%CI):1.308(1.033~1.657)]与术后并发症的发生率相关。术后重度疼痛患者神经精神系统并发症(27.2%vs 19.8%)、手术相关并发症(17.3%vs 10.2%)以及心血管系统并发症(3.6%vs 1.7%)的发生率显著升高。结论高龄、术前营养状态差、生活质量评分低、术中失血多以及术后急性疼痛控制不佳是老年患者胃肠道手术后并发症的独立危险因素。术后急性疼痛与多系统并发症存在显著相关性。Objective To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries.Methods This study was conducted among a total of 1388 elderly patients,who underwent elective gastrointestinal surgeries at 17 centers across China between April,2020 and April,2022.The primary outcome was the incidence of postoperative complications within 30 days,including procedure-related,neuropsychiatric,respiratory,cardiovascular,and gastrointestinal complications as well as acute kidney injury.Baseline characteristics,preoperative psychological and functional status,intraoperative anesthesia and surgical factors,intraoperative medication,use of nerve block,and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications.The relationship between postoperative acute pain and each type of complication were explored.Results The incidence of overall postoperative complications was 50.8%(705/1388)in these patients.Multivariate analysis showed that age(OR:1.026;95%CI:1.006-1.046),prognostic nutritional index(OR:0.998;95%CI:0.997-1.000),preoperative EuroQol-5 dimensions score(OR:0.094;95%CI:0.018-0.500),blood loss(OR:1.002;95%CI:1.001-1.003),and acute postoperative pain(OR:1.308;95%CI:1.033-1.657)were significantly associated with the occurrence of postoperative complications.Specifically,patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric(27.2%vs 19.8%),procedure-related(17.3%vs 10.2%),and cardiovascular complications(3.6%vs 1.7%).Conclusions An advanced age,a low preoperative nutritional index,a poor quality of life score,a greater volume of intraoperative blood loss,and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastr

关 键 词：胃肠道手术 老年患者 危险因素 术后并发症 疼痛 

分 类 号：R656[医药卫生—外科学]