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| 老年患者肝脏切除术后并发症的危险因素 |
| Risk factors of postoperative complications in elderly patients undergoing hepatic resection |
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| DOI：10.12089/jca.2022.01.009 |
| 中文关键词: 衰弱 老年 术后谵妄 术后并发症 肝切除术 |
| 英文关键词: Frailty Aged Postoperative delirium Postoperative complications Hepatic resection |
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| 中文摘要: |
目的 探讨行肝脏切除术的老年患者术后并发症的危险因素。
方法 选择全身麻醉下择期行肝脏切除术的肝癌患者100例，男72例，女28例，年龄65～80岁，BMI<30 kg/m2，ASA Ⅱ或Ⅲ级。根据术后3 d内是否发生并发症分为两组：非并发症组（n=69）和并发症组（n=31）。于术后1～3 d采用3D-谵妄评估（CAM）量表评估术后谵妄（POD）的发生情况。记录其他术后并发症、ICU停留时间、总住院时间、30 d内再入院及30 d内死亡情况。采用多因素Logistic回归分析术后并发症的危险因素。
结果 与非并发症组比较，并发症组年龄明显增大，BMI明显降低，ASA分级明显增高，术前衰弱、心血管疾病比例以及总胆红素含量明显升高，术中出血量明显增多，ICU停留时间和总住院时间明显延长，术后30 d再入院率明显升高（P<0.05）。多因素Logistic回归分析结果显示，年龄（每增大1岁，OR=1.404，95%CI 1.067～1.847）和术前衰弱（OR=6.497，95%CI 1.646～25.640）是术后并发症的独立危险因素。
结论 年龄增大和术前衰弱会增加老年患者肝脏切除术后并发症的发生风险。 |
| 英文摘要: |
Objective To investigate the risk factors of postoperative complications in elderly patients undergoing hepatic resection.
Methods A total of 100 elderly patients undergoing elective hepatic resection under general anesthesia were included into the study, including 72 males and 28 females, aged 65-80 years, BMI < 30 kg/m2, ASA physical status Ⅱ or Ⅲ. According to the occurrence of postoperative complications within 3 days, the patients were divided into two groups: non-complication group (n = 69) and complication group (n = 31). 3D confusion assessment method (CAM) assessment was performed for patients 1-3 days postoperatively to evaluate the occurrence of postoperative delirium (POD). The other postoperative complications, length of stay in intensive care unit (ICU) and hospital, hospital readmission within 30 days, and death within 30 days were recorded. Multivariate logistic regression analysis was used to investigate the risk factors of postoperative complications.
Results Compared with the non-complication group, the age, ASA physical status, proportion of preoperative frailty and cardiovascular disease, total bilirubin and intraoperative blood loss were significantly increased in the complication group, BMI were significantly decreased, the length of stay in ICU and hospital were significantly prolonged, and the incidences of hospital readmission within 30 days were significantly increased (P < 0.05). Multivariate logistic regression analysis showed that age (for every one year increased, OR = 1.404, 95% CI 1.067-1.847) and preoperative frailty (OR = 6.497, 95% CI 1.646-25.640) were the independent risk factors of postoperative complications.
Conclusion Increased age and preoperative frailty can increase the probalility of occurrence of postoperative complications in elderly patients undergoing hepatic resection. |
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