文章摘要
髋关节置换术后胃肠道并发症的发生率和危险因素
Incidence and risk factors for gastrointestinal complications after hip arthroplasty
  
DOI：10.12089/jca.2018.06.006
中文关键词: 髋关节置换  胃肠道并发症  发生率  危险因素  回顾性
英文关键词: Hip arthroplasty  Gastrointestinal complication  Incidence  Risk factor  Retrospective
基金项目:
作者单位E-mail
聂磊 510515,广州市,南方医科大学南方医院麻醉科  
赵秉诚 510515,广州市,南方医科大学南方医院麻醉科  
刘卫锋 510515,广州市,南方医科大学南方医院麻醉科  
李偲 510515,广州市,南方医科大学南方医院麻醉科  
刘克玄 510515,广州市,南方医科大学南方医院麻醉科 liukexuan705@163.com 
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中文摘要:
      
目的 探讨髋关节置换术后胃肠道并发症的发生率和危险因素。

方法 回顾2012年1月至2017年12月于本院行髋关节置换术的患者956例, 男466例, 女490例, 年龄17～97岁, BMI 12.9～38.0 kg/m2, ASA Ⅰ—Ⅳ 级。记录患者一般情况和术前情况，包括性别、年龄、BMI、ASA分级、伴随疾病(高血压、胃肠道手术史、胃肠道疾病史等)、心功能NYHA分级、AST、ALT和血清白蛋白（ALB）等;术中情况，包括手术方式、麻醉方式、手术时间、麻醉时间、液体入量、输血量、出血量、尿量;术后情况，包括使用镇痛泵、阿片类药物、糖皮质激素的情况、住院时间、ICU住院、术后住院时间、胃肠道并发症和其他并发症(急性心肌梗死、肺栓塞、假体脱位、假体周围感染等)。计算胃肠道并发症的发生率, 探讨胃肠道并发症的危险因素。

结果 髋关节置换术后胃肠道并发症发生率为17.2%。单因素分析显示, 与未发生胃肠道并发症患者比较, 发生胃肠道并发症患者女性比例明显升高，年龄明显增大，高血压比例明显升高，术前AST、ALB浓度明显升高(P<0.05);全麻比例明显升高, 手术时间、麻醉时间明显延长, 术中液体入量、尿量明显增多(P<0.05);住院时间、术后住院时间明显延长(P<0.05)。多因素Logistic回归分析显示,女性（OR=2.057，95%CI 1.421~2.978）、高血压（OR=1.509，95%CI 1.012~2.250）、全麻（OR=1.739，95%CI 1.200~2.521）、手术时间>1.5 h（OR=2.208，95%CI 1.474~3.308）是髋关节置换术后胃肠道并发症的独立危险因素。

结论 髋关节置换术后胃肠道并发症的发生率较高，女性患者需要更多的临床关注;维持高血压患者围术期血压平稳、慎重选择全麻、合理缩短手术时间可以降低术后胃肠道并发症的发生率。
英文摘要:
      
Objective To investigate the incidence and risk factors for gastrointestinal (GI) complications after hip arthroplasty.

Methods A total of 956 patients undergoing hip arthroplasty in our hospital from Jan, 2012 to Dec, 2017, 466 males and 490 females, aged 17-97 years, BMI 12.9-38.0 kg/m2, ASA physical status Ⅰ- Ⅳ, were retrospected in this study. All the following informations were recorded: patients’ general situation including gender, age, BMI, comorbidity (hypertension, GI surgery history, GI disease, etc.), ASA classification and NYHA classification, preoperative variables including AST, ALT, etc. intraoperative variables including operation method, anesthesia method, operation duration, anesthesia duration, fluid infusion, blood transfusion, blood loss, urine volume, and postoperative variables including use of analgesic pump, use of opioid, use of glucocorticoid, duration of hospital stay, intense care unit (ICU) hospitalization, duration of postoperative hospital stay, GI complications and other complications (acute myocardial infarction, pulmonary embolism, prosthesis dislocation, periprosthetic infection, etc.). The incidence of GI complications was calculated. Univariate analysis was performed and risk factors for GI complications were investigated.

Results The incidence of GI complications was 17.2%. Compared with patients without GI complications, patients with GI complications had increased proportion of women, increased age, increased proportion of hypertension and increased preoperative AST and ALT (P < 0.05). Patients with GI complications had increased proportion of general anesthesia, longer operation duration, longer anesthesia duration, more fluid infusion and urine volume (P < 0.05). Also, patients with GI complications had longer duration of hospital stay and postoperative hospital stay (P < 0.05). Multivariate logistic regression analysis indicated that female (OR = 2.057, 95% CI 1.421-2.978), hypertension (OR = 1.509, 95% CI 1.012-2.250), general anesthesia (OR = 1.739, 95% CI 1.200-2.521), operation duration > 1.5 h (OR = 2.208, 95% CI 1.474-3.308） were independent risk factors for GI complications after hip arthroplasty.

Conclusion The incidence of postoperative GI complications in patients undergoing hip arthroplasty is comparatively high. More attention is needed for female patients in case of GI complications. Maintaining stable perioperative blood pressure for patients with hypertension, choosing general anesthesia cautiously, and shortening operation duration rationally are important measures to reduce postoperative GI complications.
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