Sun Menghan, Xu Mengmeng, Sun Jie
Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 220009, China.
Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, China.
Heliyon. 2023 Feb 23;9(3):e13971. doi: 10.1016/j.heliyon.2023.e13971. eCollection 2023 Mar.
To investigate the relationship between intraoperative anesthesia-related factors and postoperative complications in patients undergoing emergency abdominal surgery, and to identify risk factors for these postoperative complications.
We retrospectively analyzed 942 emergency surgery patients who underwent general anesthesia and emergency abdominal operations at Jiangsu Province Hospital during the period September 2015 to December 2016. Logistic regression analysis was performed to analyze the association between preoperative or intraoperative parameters and postoperative complications.
Among the 942 patients whose data were analyzed, 226 (24.0%) had major postoperative complications within 30 days after surgery. The most common postoperative complications were respiratory complications (31.8% of those experiencing complications). After adjusting for the role of multiple confounding factors, multivariable analysis showed that the independent risk factors for postoperative complications were patient age (OR 1.648; 95% CI 1.352-2.008), the ASA classification (OR 3.220; 95% CI 2.492-4.162), intraoperative hypotension lasting more than 20 min (OR 2.031; 95% CI 1.256-3.285), intraoperative tachyarrhythmias (OR 2.205; 95% CI 1.114-4.365), and the surgical level (i.e. type and difficulty level) [OR 1.895; 95% CI 1.306-2.750].
Prolonged intraoperative hypotension (>20 min) and the occurrence of tachyarrhythmias are independent risk factors for postoperative complications in patients who undergo emergency abdominal surgery. During hemodynamic management of these patients, systolic blood pressure should be controlled to within 20% of the baseline value to reduce the risk of postoperative complications. In addition, a higher patient age, higher ASA grade, and a higher surgical classification level also significantly increase the risk of postoperative complications.
探讨急诊腹部手术患者术中麻醉相关因素与术后并发症之间的关系，并确定这些术后并发症的危险因素。
我们回顾性分析了2015年9月至2016年12月期间在江苏省医院接受全身麻醉和急诊腹部手术的942例急诊手术患者。采用逻辑回归分析来分析术前或术中参数与术后并发症之间的关联。
在分析数据的942例患者中，226例（24.0%）在术后30天内发生了严重术后并发症。最常见的术后并发症是呼吸系统并发症（占发生并发症患者的31.8%）。在调整了多个混杂因素的作用后，多变量分析显示术后并发症的独立危险因素为患者年龄（OR 1.648；95%CI 1.352 - 2.008）、美国麻醉医师协会（ASA）分级（OR 3.220；95%CI 2.492 - 4.162）、术中低血压持续超过20分钟（OR 2.031；95%CI 1.256 - 3.285）、术中快速心律失常（OR 2.205；95%CI 1.114 - 4.365）以及手术级别（即类型和难度级别）[OR 1.895；95%CI 1.306 - 2.750]。
术中低血压持续时间延长（>20分钟）和快速心律失常的发生是急诊腹部手术患者术后并发症的独立危险因素。在对这些患者进行血流动力学管理期间，收缩压应控制在基线值的20%以内，以降低术后并发症的风险。此外，患者年龄较大、ASA分级较高以及手术分级水平较高也会显著增加术后并发症的风险。
