急诊普外科手术患者术后并发症的危险因素分析

Risk factor analysis of postoperative complications in patients with emergency general surgery

目的探讨急诊普外科手术患者术中不良事件的发生与术后并发症的关系,同时分析其出现术后并发症的危险因素。方法回顾性分析南京医科大学第一附属医院2015年9月至2016年9月接受普外科手术的689例急诊患者临床资料。收集患者术前和术中相关临床指标与预后信息,分别行单因素和多因素分析各临床指标与术后并发症的相关性。结果 689例患者中,有165例(23.9%)在术后30 d内出现主要系统并发症。最常见的术后并发症为呼吸系统并发症(40.6%)。术后并发症的独立危险因素为年龄(每增加15岁,OR 1.880,95%CI 1.448~2.440)、ASA分级(每升高一级,OR 3.303,95%CI 2.303~4.736)、术中低血压持续时间>20 min(OR 2.501,95%CI 1.387~4.510)、术中快速型心律失常(OR 2.173,95%CI 1.002~4.711)以及手术级别(每增加一级,OR1.814,95%CI 1.060~3.103)。结论急诊普外科手术患者术中低血压持续时间超过20 min以及发生快速型心律失常均是出现术后并发症的独立危险因素;在对急诊手术患者进行循环管理时,尽量将其术中收缩压的下降幅度控制在20%以内,维持血流动力学的稳定,以降低术后并发症的发生风险。

Objective To investigate the relationship between the occurrence of adverse events during operation and postoperative complications in emergency general surgery patients,and to analyze the risk factors of postoperative complications. Methods We retrospectively analyzed 689 emergency general patients undergoing general anesthesia emergency surgery during the period of Sep 1,2015 to Sep 1,2016 in the First Affiliated Hospital of Nanjing Medical University. The clinical factors that may influence the outcomes and postoperative complications were collected and analyzed using univariate analysis and multivariate Logistic regression analysis. Results Among the 689 patients enrolled in the study,there were 165（ 23. 9%） patients who had major complications within 30 days after surgery. The most common postoperative complications were respiratory complications（ 40. 6%）. The independent risk factors of postoperative complications including age（ OR 1. 880,95% CI 1. 448-2. 440）,ASA classification（ OR 3. 303,95% CI 2. 303-4. 736）,intraoperative hypotension duration more than 20 minutes（ OR 2. 501,95%CI 1. 387-4. 510）,intraoperative rapid arrhythmia（ OR 2. 173,95%CI 1. 002-4. 711） and surgical level（ OR 1. 814,95%CI 1. 060-3. 103）. Conclusion Emergency general surgery in patients with intraoperative hypotension duration more than 20 minutes and the occurrence of rapid arrhythmia are independent risk factors for postoperative complications.During the circulation management of emergency surgical patients,the reduction of systolic blood pressure in the operation should be controlled within 20% of the base value to reduce the risk of postoperative complications.