南方医科大学学报

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (4): 736-743.doi: 10.12122/j.issn.1673-4254.2025.04.08

• • 上一篇    

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

吕雪彩1,2,3(), 刘艳红1,2,3, 韩诗怡1,2, 张浩赟1, 侯爱生1,2, 周志康1, 史立凯1, 高洁1, 曹江北1, 张宏1,2, 米卫东1,2,3()   

  1. 1.解放军总医院，第一医学中心麻醉科，北京 100853
    2.解放军总医院，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
  • 收稿日期:2024-11-22 出版日期:2025-04-20 发布日期:2025-04-28
  • 通讯作者: 米卫东 E-mail:524339563@qq.com;wwdd1962@163.com
  • 作者简介:吕雪彩，在读博士研究生，主治医师，E-mail: 524339563@qq.com
  • 基金资助:
    国家重点研发计划(2018YFC2001900)

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

Xuecai LÜ1,2,3(), Yanhong LIU1,2,3, Shiyi HAN1,2, Haoyun ZHANG1, Aisheng HOU1,2, Zhikang ZHOU1, Likai SHI1, Jie GAO1, Jiangbei CAO1, Hong ZHANG1,2, Weidong MI1,2,3()   

  1. 1.Department of Anesthesiology, First Medical Center, Beijing 100853, China
    2.Chinese PLA Medical School, Beijing 100853, China
    3.Department of Anesthesiology, National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital Beijing 100853, China
  • Received:2024-11-22 Online:2025-04-20 Published:2025-04-28
  • Contact: Weidong MI E-mail:524339563@qq.com;wwdd1962@163.com
  • Supported by:
    the National Key Research and Development Program of China(2018YFC2001900)

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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。

关键词: 胃肠道手术, 老年患者, 危险因素, 术后并发症, 疼痛

Abstract:

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%). Conclusion 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 gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.

Key words: gastrointestinal surgery, elderly patients, risk factors, postoperative complications, pain