老年脑膜瘤术后发生并发症的危险因素分析

Risk factors related to postoperative complications in elderly patients with meningioma

目的探讨老年(年龄≥65岁)脑膜瘤术后发生并发症的危险因素。方法回顾性分析2014年1月至2019年12月手术治疗的227例老年脑膜瘤的临床资料。术后并发症是指导致住院时间延长、术后神经功能缺失或需行各项临床操作甚至二次手术的异常情况,分为神经系统并发症(如颅内出血、癫痫、脑脊液漏、颅内感染、新发神经功能障碍、精神症状等)和全身并发症(如切口愈合不良、肺部感染、心功能异常、肝肾功能损害、消化道出血、深静脉血栓等)。结果227例中,术后56例(24.67%)有并发症,其中神经系统并发症39例,全身并发症21例。多因素logistic回归分析显示,术前KPS评分<80分、肿瘤最大直径≥6 cm、肿瘤未全切除是术后发生神经系统并发症的独立危险因素(P<0.05);美国麻醉医师协会(ASA)分级Ⅲ~Ⅳ级、术前血清白蛋白<35 g/L、术中异体输血是术后发生全身并发症的独立危险因素(P<0.05)。结论老年脑膜瘤术后并发症发生率较高。肿瘤大小及切除程度与术后神经系统并发症有关,而术前身体状况(例如ASA分级、KPS评分、血清白蛋白)、术中输血与术后全身并发症相关。

Objective To explore the risk factors of postoperative complications in the elderly patients(≥65 years old)with meningioma.Methods The clinical data of 227 elderly patients with meningioma who underwent microsurgery from January 2014 to December 2019 were analzyed retropsectively.The postoperative complications were defined as the abnormal conditions resulting in prolonged hospital stay,postoperative neurological deficits,need for various clinical operations or even secondary operations,which were divided into the neurological complications(such as intracranial hemorrhage,epilepsy,cerebrospinal fluid leakage,intracranial infections,new neurological dysfunction,mental symptoms,etc.)and systemic complications(such as poor incision healing,lung infection,abnormal heart function,liver and kidney damage,gastrointestinal bleeding,deep vein thrombosis,etc.).Results Of these 227 patients,the postoperative complications occurred in 56(24.67%)patients,including 39 neurological complications and 21 systemic complications.Multivariate logistic regression analysis showed that preoperative KPS score<80 points,maximum tumor diameter≥6 cm,and incomplete tumor resection were independent risk factors for the postoperative neurological complications(P<0.05);American Association of Anesthesiologists(ASA)gradeⅢ~Ⅳ,preoperative serum albumin<35 g/L,and intraoperative allogeneic blood transfusion were independent risk factors for the postoperative systemic complications(P<0.05).Conclusions The incidence of postoperative complications is high in the elderly patients with meningiomas.Tumor size and extent of tumor resection are related to postoperative neurological complications,while preoperative physical conditions(such as ASA grade,KPS score,serum albumin)and intraoperative blood transfusion are related to postoperative systemic complications.