老年综合评估对围术期老年病人发生术后不良事件的预测效能

Predictive efficacy of comprehensive geratic assessment for postoperative adverse events in elderly patients during perioperative period

[目的]探讨老年综合评估对围术期老年病人发生术后不良事件的预测效能。[方法]选取年龄>70岁的157例择期行腹部或骨科手术的老年病人,术前对病人进行老年综合评估,观察病人术后不良事件的发生情况和住院时间的延长情况,并分析其影响因素。[结果]157例病人中,男80例,女77例,平均年龄75.98岁±5.36岁;腹部手术108例,骨科手术49例;发生术后并发症25例,住院时长>17d的有69例。单因素分析显示:共病(P=0.010)、认知功能(P=0.000)、衰弱(P=0.005)、日常生活能力(P=0.012)、血肌酐(P=0.005)是围术期老人术后发生并发症的影响因素;手术类型(P=0.001)、婚姻状况(P=0.040)、文化程度(P=0.016)、共病(P=0.023)、血红蛋白(P=0.003)、血清清蛋白(P=0.001)是围术期病人住院时长的影响因素。多元logistic回归分析显示:共病(OR=0.356)、认知功能损害(OR=0.222)、老年综合征的评估个数(OR=0.202)是围术期病人发生术后并发症的独立影响因素;共病(OR=0.315)、手术分类(OR=0.771)、血清清蛋白(OR=0.662)是围术期老年病人住院时长的独立影响因素。[结论]对择期行腹部或骨科手术的老年病人进行老年综合评估有助于识别发生术后并发症及住院时间延长的高危病人。

Objective： To probe into the predictive efficacy of postoperative comprehensive assessment of postop-erative adverse events in elderly patients with perioperative period. Method： A total of 157 elderly patients who underwent abdominal or orthopedic surgery were enrolled in the year of June 2015 to October 201 5,and the pa-tients were evaluated for the elderly before surgery. The incidence of postoperative adverse events and pro-longed hospitalization situation were observed ？ and its influencing factors were analysed. Results： Among the 157 patients？80 were male and 77 were female,with an average age with 75. 98±5. 36 years？ 108 cases with ab-dominal surgery and 49 cases of orthopedic surgery. There were 25 cases of postoperative complications and 69 cases of hospital stay〉17 days. Univariate analysis showed that co - morbidities（P = 0. 010） , cognitive function （F = 0. 000） , weakness （F = 0. 005） ,daily living ability （P = 0. 0 1 2 ） ,serum creatinine （P = 0.005）were influen-cing factors in postoperative complications. Operation type（P = 0. 001）, marital status（F = 0. 040）, degree of ed- ucat.ion（P = 0. 01 6）, co - morbidities（P = 0. 023）. hemoglobin （P = 0. 003）, serum clearance（P = 0. 001） were in-fluencing factors in perioperative hospital stay. Multivariate logistic regression analysis showed that co - mor-bidities （OR= 0. 356） , cognitive impairment （OR = 0. 222） , and the number of elderly syndrome （OR = 0. 202） were independent factors of perioperative postoperative complications. Co - morbidities （OR = 0. 315）, operation type（F = 0. 771） , serum albumin （OR = 0. 662） was an independent influencing factor in the duration of periop-erative care. Conclusions ： The elderly comprehensive assessment in elderly patients undergoing abdominal or orthopedic surgery was helpful for identifying high - risk patients who had postoperative complications and pro-longed hospitalization.