食管支架贴覆不良现象的危险因素

目的探讨食管支架植入术后贴覆不良现象（ESDP）的发生及相关危险因素。方法收集98例接受食管支架植入术的恶性肿瘤患者,对术后7例发生ESDP者,选取9个危险因素,包括：年龄、性别、梗阻部位、是否伴食管-气管瘘、既往有无外科手术史、放疗史、梗阻远端扩张程度、是否为喇叭形支架、支架覆膜与否,以Logistic回归分析危险因素。结果本组ESDP发生率为7.14%,主要表现为术后不同程度的吞咽困难或呛咳,并伴有持续胸痛,以进食时加重。食管造影可见支架内对比剂通过顺畅,但在支架与食管壁之间对比剂明显滞留。Logistic回归分析显示阳性因素为既往放疗病史（P=0.005）及梗阻远端扩张程度（P=0.017）。结论ESDP为食管支架植入术后并发症之一。对于既往有放疗病史且梗阻上方明显扩张者,需慎行食管支架植入术。     

肝癌肝切除术后感染并发症相关危险因素分析

目的 探讨肝癌肝切除术后感染并发症相关危险因素.方法 对本院近6年来行肝切除术的217例肝癌患者的临床资料进行回顾性分析,对可能引起感染并发症的因素进行统计学分析.结果 217例肝癌肝切除病例根据术后是否发生感染并发症分为感染组（n=33）与非感染组（n=184）.33例中,手术部位感染15例（占45.45％）、肝脏周围感染4例（占12.12％）、远处部位感染14例（占42.42％）;术后死亡3例（占1.38％）.多因素Logistic逐步回归分析显示年龄（P=0.006,0R=2.564）、糖尿病史（P=0.02,OR=1.996）、手术时间（F=0.005,0R=2.237）及胆漏发生率（P＜0.001,0R=7.325）是肝切除术后感染并发症的独立危险因素.结论 年龄、糖尿病史、手术时间及胆漏发生率是影响肝癌患者肝切除术后感染并发症发生的独立危险因素.     

持续低氧血症对食管重建术后吻合口狭窄的影响

目的分析食管重建术后吻合口瘢痕狭窄的相关因素，尤其相关的全身性因素。方法回顾性分析中山大学附属肿瘤医院收治的1111例食管癌切除、消化道重建术患者的病例资料，对可能导致吻合口瘢痕狭窄的全身及局部因素进行logistic单因素、多因素回归分析，并对筛选出的因素进行相关分析。结果单因素回归分析显示：术后持续低氧血症（P=0．003）、胸部并发症（P=0．000）、吻合口瘘（P=0．000）、糖尿病史（P=0．019）、慢性阻塞性肺病病史（P=0．046）和心血管并发症（P=0．015）6项因素有统计学意义；而多因素回归分析则显示仅持续低氧血症（P=0．044）、胸部并发症（P=0．009）、吻合口瘘（P=0．001）和糖尿病史（P=0．036）4项因素有统计学意义：相关分析显示：持续低氧血症与胸部并发症及吻合口瘘三者之间呈正相关。结论持续低氧血症是食管重建术后吻合口瘢痕狭窄的重要全身性因素。     

骨科手术后患者切口感染危险因素分析及创面修复处理对策

目的 总结骨科手术后患者切口感染的危险因素,探讨切口感染的创面修复处理对策。方法 选取2018年2月-2023年2月在我院骨科进行手术治疗的1480例患者为研究对象,采用统计方法收集术后 感染情况数据,运用Logistic回归分析法对手术切口感染的危险因素进行分析。结果 1480例骨科手术 患者中有23例发生切口感染,感染率为1.55%;单因素分析显示,不同年龄、手术切口类型、手术时 间、有无基础疾病、围术期用药、手术部位的切口感染发生率比较,差异有统计学意义（P＜0.05）; 多因素分析显示手术切口类型（OR=1.462）、年龄（OR=1.526）、手术时间（OR=1.812）、基础疾 病（OR=2.340）、围术期用药（OR=1.402）是骨科术后切口感染的影响因素（P＜0.05）。结论 导致 骨科手术患者术后切口感染的影响因素较多,包括手术切口类型、年龄、手术时间、基础疾病和围术期 用药。对此,应重点关于以上危险因素人群,并予以针对性干预,以期减少骨科手术后切口感染的发生 几率。     

大动脉炎开放手术围手术期并发症的危险因素分析

目的：探讨影响大动脉炎（TA）患者行开放手术治疗发生围手术期并发症的相关危险因素。 方法：回顾性分析2003年1月—2018年12月136例行开放血管重建治疗的TA患者资料,采用单因素及多因素Logistic统计学方法分析影响开放手术围手术期并发症的相关危险因素。 结果：136例患者共行开放手术141例次,涉及病变257处。围手术期并发症共发生36例次（25.5%）,其中5例患者（3.7%）死亡。单因素分析结果显示,脑梗死病史、术前CRP升高、颈动脉受累、围手术期输血、血管受累数量、动脉阻断时间及术中出血量与围手术期并发症的发生有关（均P<0.05）;多因素Logistic分析显示,脑梗死病史（OR=3.141,95% CI=1.062~9.288,P=0.039）、血管受累数量（OR=1.280,95% CI=1.016~1.612,P=0.036）和术中动脉阻断时间（OR=1.045,95% CI= 1.007~1.084,P=0.019）是围手术期并发症的独立危险因素。 结论：术前脑梗死病史,血管受累数量多和术中动脉阻断时间长会增加TA患者开放手术围手术期并发症的风险。     

43例骨肉瘤患者预后的多因素分析

目的：探讨影响骨肉瘤患者预后的相关因素。方法：回顾性分析2005年3月至2007年3月手术治疗并经病理证实的43例骨肉瘤患者的临床资料,包括性别、年龄、部位、病程、化疗前血清碱性磷酸酶水平、术前化疗、En-neking分期、手术方式及远处转移情况等9项相关因素,采用Kaplan-Meier法计算生存率,应用Log-rank检验行单因素分析,COX检验行多因素分析,研究这些因素与骨肉瘤患者3年生存率之间的关系。采用精确概率Fisher检验研究化疗疗效对骨肉瘤患者预后的影响。结果：43例均获随访,28例存活,15例死亡,生存时间6～65个月,平均39.7个月,中位生存时间42个月,3年总生存率65.1%。单因素分析显示,骨肉瘤预后与部位（P=0.010）、Enneking分期（P=0.002）、手术方式（P=0.000）、远处转移（P=0.002）有相关性;COX多因素分析显示Enneking分期（P=0.028）、手术方式（P=0.001）及远处转移（P=0.007）是影响骨肉瘤患者预后的独立因素。Fisher精确检验显示,尽管术前是否行新辅助化疗对预后影响不明显,但是新辅助化疗疗效的好坏是患者预后的重要影响因素（P=0.007）。结论：骨肉瘤预后与En-neking分期、手术方式及远处转移密切相关,早期发现及充分切除肿瘤是提高骨肉瘤预后可干预措施。     

脊柱后路内固定手术后手术部位感染的危险因素及治疗策略

【摘要】 目的：探讨脊柱后路内固定手术后手术部位感染的相关危险因素及治疗策略。方法：回顾性分析2015年1月~2018年1月在我院骨科行脊柱后路内固定手术患者3780例。其中男性1970例,女性1810例,年龄18~92岁（44.9±18.4岁）,随访1.5±0.3年。根据患者术后1年内是否出现感染分为感染组和非感染组。收集两组患者的年龄（是否＞60岁）、性别、体质指数（body mass index,BMI）（是否＞30kg/m2）、融合节段（是否＞2个）、手术持续时间（是否＞3h）、低蛋白血症（白蛋白是否＜35g/L）、是否贫血、是否合并糖尿病、是否异体输血、术后引流时间（是否＞48h）、失血量（是否＞1000ml）以及是否合并其他部位感染等资料进行独立样本t检验。对阳性结果进行进一步多因素Logistic回归分析,将感染组根据感染灶是否穿破深筋膜分为浅表感染组和深部感染组,收集感染组细菌培养结果,χ2检验分析病原菌构成比。结果：3780例患者中发生手术部位感染患者95例,感染发生率为2.51%,其中男性52例,女性43例,年龄18~82岁（43.5±15.2岁）。单因素分析显示,两组患者在性别、BMI＞30kg/m2、融合节段、贫血、异体输血、术后引流时间以及合并其他感染等因素比较差异无统计学意义（P＞0.05）,而在年龄＞60岁、手术时间超过3h、低蛋白血症（白蛋白＜35g/L）、合并糖尿病和失血量＞1000ml等因素存在统计学差异（P＜0.05）。多因素Logistic回归结果显示年龄＞60岁（OR=5.267,P=0.008）、手术时间超过3h（OR=7.156,P=0.000）、低蛋白血症（OR=4.358,P=0.016）、合并糖尿病（OR=3.578,P=0.005）和失血量＞1000ml（OR=4.659,P=0.007）是脊柱后路内固定术后手术部位感染的独立危险因素。95例脊柱后路手术术后手术部位感染患者根据感染部位分为浅表感染65例,深部感染30例,病原菌构成比比较无统计学意义（P＜0.05）。结论：年龄＞60岁、手术时间超过3h、低蛋白血症、合并糖尿病和失血量＞1000ml的患者行脊柱后路内固定手术术后发生切口感染的风险较高,围手术期应积极采取有效的治疗策略,最大限度降低脊柱内固定术后手术部位感染的发生。     

小儿气道异物并发症与其留存时间的关系探讨

目的探讨小儿气道异物并发症与其留存时间的关系。方法选择笔者所在医院2007年1月～2010年12月入耳鼻喉科因气道异物进行手术的患儿60例,按异物存留时间分为3组：甲组（异物存留于气道的时间〈24h）患儿25例;乙组（异物存留于气道的时间在24h～7d之间）患儿20例;丙组（异物留存于气道的时间时间〉7d）患儿15例。记录并比较三组患儿的术前合并肺炎情况、苏醒期喉痉挛,术中及苏醒期低氧血症的发生情况。结果三组患儿的术前肺炎发生率、苏醒期喉痉挛发生率比较,差异有统计学意义（P〈0.05）。但术中、苏醒期低氧血症发生率组间比较无统计学意义（P〉0.05）。结论小儿气道异物留存于气道的时间越长,肺部并发症、苏醒期喉痉挛的发生率就越高,故应尽早明确诊断及实施手术。另外,术中和苏醒期都要警惕低氧血症的发生,这些均对患儿的预后有重要意义。     

重症急性胰腺炎病程后期并发急性胆囊炎危险因素分析

目的：探讨重症急性胰腺炎（SAP）病程后期并发急性胆囊炎（AC）的危险因素。方法：采用病例对照研究的方法,回顾性收集确诊的20例SAP并发AC（SAP-AC）患者为病例组和86例SAP患者为对照组的各项资料,采用单因素和多因素非条件Logistic回归法筛选危险因素。结果：单因素Logistic回归分析显示Balthazar’CT评分、APACHEⅡ评分、全身并发症、局部并发症、生长抑素时间、EN持续时间、输血、手术等12个变量影响并发AC的发生;多因素Logistic回归分析显示APACHEⅡ评分（OR=1.333）、肠道营养（EN）持续时间（OR=1.020）、胰头部坏死组织感染（OR=3.301）为并发AC的重要影响因素。结论：APACHEII评分越高、EN持续时间越长、胰头部坏死组织感染,其并发AC的风险性就越大,均为危险因素。     

腹腔镜低位直肠前切除术并发症的影响因素分析

目的探讨腹腔镜直肠癌低位前切除术并发症的影响因素，为降低并发症的发生、提高手术疗效提供依据。方法回顾性研究2004年8月～2007年7月我院132例根治性腹腔镜直肠癌低位前切除术的临床资料，收集所有手术并发症病例，通过单因素和多因素统计分析筛选其危险因素。结果除5例术中采用手助方式外，余127例为腹腔镜辅助下低位直肠前切除术，无中转开腹。手术并发症发生率为20．5％（27／132），其中吻合口漏（8．3％，11／132）的发生率最高。二分类Logistie回归方程筛选得出肿瘤大小（直径≥3cm）、肿瘤部位（距肛缘距离≤6cm）和病理TNM分期为影响并发症发生的独立危险因素，相对危险度分别为1．149、0．552、2．816。结论手术并发症中吻合口漏的发生率最高；肿瘤大小、肿瘤部位和病理分期是影响手术并发症发生的独立危险因素。     

结直肠癌患者腹腔镜根治术后并发症的影响因素研究

目的:探讨结直肠癌患者腹腔镜根治术后并发症的影响因素,为提高手术疗效提供有利依据。方法:回顾分析2011年1月至2013年1月156例结直肠癌患者的临床资料,根据有无并发症分为无并发症组与并发症组,通过单因素及多因素分析筛选并发症的影响因素。结果:单因素分析显示,患者的性别、发病年龄、术前合并症、术者手术经验、新辅助治疗、手术时间、肿瘤位置及TNM分期与结直肠癌腹腔镜根治术后并发症相关。多因素回归分析显示,性别、术前合并症、术者手术经验、肿瘤位置及TNM分期是影响结直肠癌患者腹腔镜根治术后并发症发生的独立危险因素。并发症组患者的住院时间明显长于无并发症组(P<0.05)。结论:性别、术前合并症、术者手术经验、肿瘤位置及TNM分期是影响结直肠癌患者腹腔镜根治术后并发症发生的独立危险因素,术中应尤其注意伴有并发症危险因素的患者,以提高手术疗效。     

Vascular complications of intra-aortic balloon insertion in patients undergoing coronary reavscularization: analysis of 911 cases.

OBJECTIVE: Intra-aortic balloon pump (IABP) is a well-accepted and widely used mechanical circulatory support in cardiac surgical practice. We evaluated the vascular complications of IABP and risk factors associated with the development of these complications in patients undergoing myocardial revascularization. METHODS: Between January 1994 and December 2000, a total of 911 patients undergoing coronary artery bypass grafting received IABP. The preoperative risk factors, balloon-related variables and vascular complications were studied and analyzed. Univariate and multivariate analyses were performed to identify risk factors for the development of vascular complications. RESULTS: Mean age of the patients was 59.2+/-9.1 years and 10.5% of the patients were female. The incidence of diabetes and peripheral vascular disease was 41.1 and 8.5%, respectively. The mean Parsonnet score was 11.8+/-4.6. IABP was inserted by percutaneous technique in 96.8% of patients. The duration of IABP therapy ranged from 20 h to 21 days (mean 3.8 days). Fifty-four (5.9%) patients developed major and 53 (5.8%) patients developed minor vascular complications. Ischaemia of the limb, requiring thromboembolectomy, developed in 25 (2.7%) patients. Patients who received IABP preoperatively had higher incidence of major vascular complications as compared to patients who received IABP in operating room before induction of anaesthesia. Multiple logistic regression analysis revealed age, triple vessel disease, indications of IABP therapy (unstable angina, cardiac arrhythmia and haemodynamic instability), left ventricular aneurysm surgery and use of balloon with sheath as independent risk factors for the development of vascular complications. CONCLUSIONS: IABP therapy is associated with certain vascular complications, which should always be kept in mind before insertion of a balloon. The use of a balloon without sheath and proper evaluation of peripheral circulation can help to minimize the development of vascular complications.     

Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures

From January, 1979, to December, 1984, at the Cardiac Surgery Department of the University of Torino Medical School, major sternal wound infections developed in 48 (1.86%) of 2,579 consecutive patients. These patients underwent open-heart procedures through a midline sternotomy and survived long enough for infection to appear. Possible risk factors were evaluated by means of a multivariate analysis. For the group of patients, we considered age, sex, hospital environment (different locations of our surgical facilities over the years), interval between hospital admission and operation, antibiotic prophylaxis, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of treatment in the intensive care unit. Univariate analysis indicated that age, sex, type and mode of surgical procedure, antibiotic prophylaxis, and duration of mechanical ventilation were not significantly associated with wound infection. For all other predisposing factors, a p value of less than .05 was demonstrated. These variables were entered in a multiple stepwise logistic regression. Six emerged as significant: hospital environment (p = .0001), interval between admission and surgery (p = .041), reoperation (p less than .0001), blood transfusions (p = .031), early chest reexploration (p less than .0001), and sternal rewiring (p less than .0001). Contamination of patients may occur before, during, and after operation, and any kind of reintervention may predispose to wound infection.     

210例乳腺癌患者的危险因素分析

目的:通过对乳腺癌患者临床资料的调查分析,了解乳腺癌的临床流行病学特征,探讨乳腺癌发病的相关危险因素,为乳腺癌的预防提供一定的参考依据。方法:采用病例对照研究方法,选取2005年1月—2012年1月经病理学确诊的乳腺癌患者210例作为病例组,同时随机选择同期已证实为良性乳腺疾病的210例患者作为对照组,采用统一设计的调查表,由经过统一培训的调查员对研究对象进行面对面的问卷调查。单因素分析采用单因素条件Logistic回归分析,多因素分析采用条件Logistic回归模型进行统计分析,探讨与乳腺癌的发病有关的危险因素。结果:单因素分析结果显示,文化程度高、接触职业性有害物质、被动吸烟、绝经年龄大、流产、肿瘤家族史、长期精神压抑、负性生活事件、肉类烟熏食物摄入次数多这9个因素是乳腺癌的危险因素;体育运动、初潮年龄晚、月经规律、生育孩子次数多、母乳喂养、母乳喂养持续时间长以及蔬菜摄入次数多这7个因素是乳腺癌的保护因素。多因素分析结果显示,文化程度高、绝经年龄大、肿瘤家族史、负性生活事件、肉类摄入次数多是乳腺癌的危险因素;初潮年龄晚、月经规律、母乳喂养持续时间长、蔬菜摄入次数多为保护因素。结论:乳腺癌患者住院治疗人数呈显著增加趋势,其发生与患者的居住环境、生活方式和习惯、女性生理与生育、家族史、饮食因素、精神心理因素密切相关,因此对其的预防应采取具有针对性的综合性措施。     

胆囊切除术后综合征相关危险因素分析

[摘要]目的探讨胆囊切除术后综合征发生的相关危险因素。方法回顾性分析我院2006年1月-2011年1月治疗的542例行胆囊切除术患者的临床资料,分别对可能与胆囊切除术后综合征发生相关的因素进行分析,采用单因素与多因素分析筛选出相关因素。结果542例患者中,142例发生胆囊切除术后综合征。单因素分析结果显示性别（P=0．026）、胆囊管残留过长（P=0．022）、Oddi括约肌狭窄（P=0．002）与胆囊切除术后综合征发生相关;多因素分析显示Oddi括约肌狭窄（RR=11．563,P=0．017）为胆囊切除术后综合征发生的独立危险因素。结论Oddi括约肌狭窄为胆囊切除术后综合征发生的独立危险因素。     

Surgical site infections in plastic surgery: an italian multicenter study

BACKGROUND: Plastic surgery interventions have increased in terms of frequency, complexity of surgical procedures, and postoperative complications, particularly surgical site infections (SSIs). The aim of the present study was to assess the SSI frequency in plastic and reconstructive surgery settings in Italy and to evaluate the associated risk factors. METHODS: From June 2004 to June 2005, a prospective multicenter study including 2806 consecutive patients was conducted in 23 Italian plastic and reconstructive units. To assess potential risk factors for surgical site infection, a conditional logistic regression model was used and results were exposed in terms of odds ratio (OR) with their respective 95% confidence interval (CI). RESULTS: SSIs occurred in 85/2806 (3%) patients. Sixty (70.6%), 24 (28.2%), and 1 (1.2%) SSIs were classified as superficial, deep, and organ/space, respectively. Sixty-six percent of the SSIs were diagnosed during postdischarge surveillance. At multivariate analysis, diabetes mellitus, chronic obstructive pulmonary disease, preoperative radiotherapy, and use of surgical drains were significantly associated with the occurrence of SSI. CONCLUSIONS: Our findings, based on a large population including all types of plastic and reconstructive interventions, provided consistent information on potential risk factors for SSI in this surgical setting. Moreover, the high rate of SSI found during the postdischarge surveillance underlines the need for improving active surveillance methodologies in this surgical setting.     

Surgical site infection following operative treatment of open fracture: Incidence and prognostic risk factors

Considering the high incidence of postoperative complications of open fracture, management of this injury is an intractable challenge for orthopaedist, and surgical site infection (SSI) is the devastate one. Screening for high‐risk patients and target them with appropriate interventions is important in clinical practice. The aim of this study was to identify modifiable factors that were associated with SSI following operative treatment of open fractures. This retrospective, multicentre study was conducted at three hospitals. A total of 2692 patients with complete data were recruited between June 2015 and July 2018. Demographic characteristics, operation relative variables, additional comorbidities, and biochemical indexes were extracted and analysed. Receiver operating characteristic analysis was performed to detect the optimum cut‐off value for some variables. Univariate and multivariate logistic analysis models were performed, respectively, to identify the independent risk factors of SSI. The overall incidence of SSI was 18.6%, with 17.0% and 1.6% for superficial and deep infection, respectively. Results of univariate and multivariate analyses showed the following: fracture type, surgical duration > 122 minutes, anaesthesia time > 130 minutes, intraoperative body temperature < 36.4°C, blood glucose (GLU) > 100 mg/dL, blood platelet (PLT) < 288 × 10⁹, and white blood cells (WBC) > 9.4 × 10⁹ were independent risk factors of postoperative wound infection following operative treatment of open fractures. Six modifiable factors such as surgical duration > 122 minutes, anaesthesia time > 130 minutes, intraoperative body temperature < 36.4°C, GLU > 100 mg/dL, PLT < 288 × 109, and WBC > 9.4 × 109 play an important role in the prevention of SSI, and these factors should be optimized perioperatively.     

甲状腺结节术前检查对良恶性诊断的预测价值

目的探寻可以预测甲状腺结节良恶性的术前检查指标,更加准确地预测甲状腺结节的病理类型,从而减少良性甲状腺结节的手术率。方法回顾性分析2011年1月至12月间接受甲状腺结节手术的病例资料,单因素和Logistic多因素分析术前临床指标和术后病理结果,确定可以预测甲状腺结节良恶性的危险因素。结果恶性结节在所有手术结节中的比例为22％。单因素分析和多因素分析显示,超声检查结果如单发结节、形态不规则或纵径大于横径的结节、混合回声或低回声、细小钙化、边界不清和血供丰富与恶性甲状腺结节相关。结论甲状腺恶性结节在手术结节中所占的比例较小;B超对甲状腺结节的诊断指标对结节良恶性的判断有意义;合理利用这些指标可以很好地判断甲状腺结节的病理类型,从而减少良性甲状腺结节的手术。     

A preoperative index of mortality for patients undergoing surgery of type A aortic dissection.

BACKGROUND: The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. METHODS: From January 1985 to June 1998, 108 patients underwent surgery for type A aortic dissection. 89.9% of the patients had an acute type A dissection (AD), whereas 11.1% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 22% and 14.8% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 71.2% of the cases, in the arch in 16.6% and in the descending aorta in 7.4%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. A predictive model of in-hospital mortality was then constructed by means of a mathematical method with the variables selected from logistic regression analysis. RESULTS: The overall in-hospital mortality rate was 20.3% (22/108 patients), being 9% for CD and 21.6% for AD. Emergent procedures had an in-hospital mortality rate of 47.6%, whereas non-emergent operations had an in-hospital mortality rate of 13.7% (p<0.01). Univariate analysis revealed among 39 preoperative and operative variables, age (years), age >70 years, remote myocardial infarction, cerebrovascular dysfunction, diabetes, preoperative renal failure, shock, cardiopulmonary bypass time (minutes), emergency operation as factors associated to in-hospital death (p<0.05). Stepwise logistic regression analysis selected as independent predicting variables (p<0.05), remote myocardial infarction (p=0.006), preoperative renal failure (p=0.032), shock (p=0.001), age >70 years (p=0.007). Finally, a probability table of death risk was obtained with the logistic regression coefficients. The lower death probability (10.6%) was calculated in absence of risk variables; the higher one in presence of all of them (79.7%). Between these extremes, a total of 64 combinations of death risk were obtained. CONCLUSIONS: Increasing age, shock, coronary artery disease and renal failure are variously associated to a high risk of in-hospital death after surgical correction of type A aortic dissection. This predictive model of death probability allows to collocate preoperatively patients with type A aortic dissection at different levels of risk for in-hospital death.     

老年骨科患者术前并存病与围手术期内术后严重结局相关性分析(附201例报告)

目的探讨老年骨科患者术前并存疾病与围手术期内术后结局的相关性。方法总结201例65岁及以上的骨科手术临床经验,观察期限于围手术期。统计术前伴有疾病、围手术期内术后结局等指标,将术前并存疾病与围手术期内结局首先进行单因素分析,采用χ2检验,将单因素分析有意义的因素(P<0·05)再进行Logistic多元逐步回归分析。P<0·05作为有统计学意义的标准。结果201例中,15例围手术期内术后发生并发症,占7·5%,7例死亡,占3·5%。单因素分析显示,较严重的呼吸系统疾病等与老年骨科患者围手术期内术后死亡有统计学意义;房颤等术前并存病与围手术期内非死亡性并发症有统计学意义(P<0·05)。Logistic多元逐步回归分析发现,较严重的呼吸系统疾病等与术后死亡密切相关。结论老年患者术前并存较严重呼吸系统疾病、心肌供血不足、严重肾功能不全等因素对围手术期内术后死亡结果有显著影响。