老年患者前路腰椎间融合术后肠梗阻的危险因素

Risk factors of postoperative ileus after anterior lumbar interbody fusion in elderly patients

目的探讨老年患者前路腰椎间融合术(Anterior lumbar interbody fusion,ALIF)术后肠梗阻(postoperative ileus,PI)的危险因素。方法选择2011年1月~2020年1月在本院接受ALIF治疗的497例老年患者病历资料,记录患者的性别、年龄、体质量指数、美国麻醉师协会(American society of anesthesiologists,ASA)评分、合并疾病、个人史、腰椎疾病类型、手术节段、失血量、手术时间、手术医师资历、围手术期电解质失衡等资料,观察患者PI发生率及影响PI发生的风险因素。结果497例患者共诊断PI47例(9.48%)。单因素分析显示,PI组和非PI组患者的性别、体质量指数、吸烟、糖尿病、高脂血症、胃食管反流、慢性便秘、手术节段、失血量、手术时间、电解质紊乱和镇痛方式等资料差异存在统计学意义(P<0.05);多因素Logistic回归分析显示,男性、电解质紊乱、胃食管反流、慢性便秘是PI发生的风险因素(P<0.05),氟比洛芬酯联合阿片类药物镇痛是PI发生的保护性因素(P<0.05)。结论ALIF患者术后继发PI受多种因素影响,早期识别这些风险因素有助于指导ALIF的手术决策和围手术期管理方式的改进。

Objective To investigate the risk factors of postoperative ileus(PI)in elderly patients after anterior lumbar interbody fusion(ALIF).Methods The medical records of 497 elderly patients who received ALIF treatment in our hospital from January 2011 to January 2020 were analyzed.The data of gender,age,body mass index,American society of anesthesiologists(ASA)score,comorbidities,personal history,types of lumbar diseases,operative segments,blood loss,operation time,surgeon,perioperative electrolyte imbalance were recorded.The incidence of PI and risk factors affecting PI were observed.Results A total of 47 cases of PI were diagnosed in 497 patients,and the incidence rate of PI was 9.48%.Univariate analysis showed that the gender,body mass index,smoking,diabetes,hyperlipidemia,gastroesophageal reflux,chronic constipation,operation segment,blood loss,operation time,electrolyte imbalance and sedation between PI group and non-PI group had statistically significant differences(P<0.05).Multivariate logistic analysis showed that male,electrolyte disorder,gastroesophageal reflux and chronic constipation were the risk factors of PI(P<0.05),and flurbiprofen axetil combined with opioid analgesia was the protective factor(P<0.05).Conclusion PI of patients with ALIF is affected by many factors.Early identification of these risk factors is helpful to guide the surgical decision-making and improve the perioperative management.