老年消化道疾病患者围手术期死亡病例分析

Analysis of death cases in elderly patients with digestive tract disease during perioperative period

目的分析老年消化道疾病患者围手术期死亡的主要原因,探讨降低病死率的方法。方法回顾性总结1990至2003年2891例老年消化道患者的临床资料,对其中61例围手术期死亡患者进行分析。用Logisitic回归方法分析患者的血红蛋白、白蛋白、血压、心脏病、糖尿病等与围手术期病死率的关系。结果在2891例中,并存心血管疾病者1338例(46.2%),呼吸系统疾病813例(28.1%),糖尿病449例(15.5%),肾功能不全348例(12.1%),贫血(血红蛋白低于110 g/L)796例(26.2%),低蛋白血症(白蛋白低于35 g/L)442例(22.2%),围手术期死亡61例(2.1%),死亡的主要原因为心血管系统并发症、呼吸系统并发症和肾功能衰竭等。Logisitic回归分析结果显示:术前心血管疾病、低蛋白血症与围手术期病死率明显相关。结论加强老年消化道患者围手术期的处理对降低病死率有重要意义。

Objective To analyze the main causes of death and explore methods to decrease the mortality of elderly patients with digestive tract disease during perioperative period. Methods A retrospective analysis of the clinical data from 1990 to 2003 was performed in 2891 elderly patients with digestive tract disease, and 61 death cases were analyzed. Logisitic regression was used to analyse the relationship of hemoglobin, albumin, blood pressure, cardiovascular disease and diabetes with the rate of perioperative death. Results Among 2891 elderly cases with digestive tract disease, cardiovascular disease coexisted in 1338 cases（46.2%）; respiratory disease, 813（28.1%） ; diabetes, 449（15.5%）; renal dysfunction, 348（12.1%）; anemia（hemoglobin〈110 g/L）, 796 （26.2%）; hypoalbuminemia（albumin〈35 g/L）, 442 （22.2%）. Perioperative mortality was 2.1% （61 cases） . The sequence of the main death causes was cardiovascular complications〉respiratory complications〉 renal dysfunction. Logisitic regression showed that cardiovascular disease and hypoalbuminemia were correlated with perioperative death rate significantly. Conclusions Improving the perioperative management is very important for lowering the perioperative mortality in elderly patients with digestive tract disease.