老年患者术后肠道功能恢复的影响因素

Risk factors of postoperative intestinal function recovery in elderly patients

目的探讨老年患者术后肠道功能恢复的影响因素。方法回顾性分析2019年1—12月择期手术患者3359例,男1538例,女1821例,年龄≥65岁,ASAⅠ—Ⅳ级,根据术后24 h是否排气分为两组:已排气组(n=1463)和未排气组(n=1896)。比较两组性别、年龄、BMI、ASA分级、是否合并高血压、麻醉方式、手术时间、手术科室、术毕去向、术后是否采用镇痛泵等。对两组有统计学差异的指标及临床可能相关影响因素,采用多因素Logistic回归分析影响术后肠道功能恢复的危险因素。结果与已排气组比较,未排气组男性、ASAⅢ或Ⅳ级、全身麻醉、普外科手术、术后未使用镇痛泵比例更高。Logistic回归分析显示,全身麻醉(OR=1.30,95%CI 1.02~1.67)、普外科手术(OR=2.05,95%CI 1.61~2.61)、术毕回ICU(OR=2.08,95%CI 1.74~2.48)以及术后未使用静脉镇痛泵(OR=9.50,95%CI 7.45~12.11)是影响老年患者术后肠道功能恢复的独立危险因素。结论慎重选择全身麻醉,加强关注普外科以及术毕需回ICU患者的术后肠道功能情况,术后使用镇痛泵并采用多模式镇痛有助于老年患者术后肠道功能恢复。

Objective To explore the risk factors of postoperative intestinal function recovery in elderly patients.Methods A total of 3359 patients,1538 males and 1821 females,aged≥65 years,ASA physical statusⅠ-Ⅳ,were included who were operated during Jan,2019 to Dec,2019.The patients were divided into two groups according to whether or not they had postoperative flatus.Their gender,age,BMI,ASA physical status,hypertension,anesthesia mode,operation time,department of operation,destination after operation,and analgesia pump were analyzed and compared between the two groups.Having flatus or not as the outcome variable,the risk factors of postoperative intestinal function recovery were analyzed by Logistic regression.Results Compared with the flatus group,the non-flatus group had increased the proportion of men,ASA physical statusⅢorⅣ,general anesthesia,department of general surgery,ICU as the destination after operation and analgesia pump(P<0.1).The Logistic regression results showed that general anesthesia(OR=1.30,95%CI 1.02-1.67),department of general surgery(OR=2.05,95%CI 1.61-2.61),ICU as the destination after operation(OR=2.08,95%CI 1.74-2.48),and without analgesia pump(OR=9.50,95%CI 7.45-12.11)were independent risk factors for postoperative intestinal function recovery in elderly patients.Conclusion It is cautious to choose general anesthesia.More attention is needed for patients of department of general surgery and ICU.The analgesia pump is helpful to the recovery of postoperative intestinal function in elderly patients.