老龄肠梗阻病人急诊手术并发症发生的危险因素分析及对策

目的探讨老龄肠梗阻病人急诊术后并发症发生的危险因素和处理策略。方法回顾性分析解放军第一〇五医院普外科2010年1月至2015年12月间行急诊手术干预57例老龄肠梗阻病人围手术期临床资料。结果 57例病人的年龄为70~105岁,平均(78.3±7.3)岁,其中24例病人(42.1%)发生了各种并发症48例次,包括肺部感染9例,术后肠梗阻3例,切口感染11例,急性肾损伤2例,低蛋白血症17例,心律失常6例。术前合并低蛋白血症、高血糖、贫血、营养不良及手术时间较长的病人术后容易出现常见手术并发症,而年龄、心脑血管疾病、水电解质紊乱及酸碱失衡则对此无明显影响。结论术前多种因素引起了病人术后并发症的出现,与病人术前各种合并疾病、病变本身因素以及手术方式的选择有关,没有单一的绝对因素决定术后并发症的出现。加强对老龄病人合并疾病的围手术期处理是减少老龄肠梗阻病人术后早期并发症的重要措施之一。

Perioperative treatment of elderly patients with intestinal obstruction

Objective To investigate the risk factors and management of the perioperative complications in elderly patients with intestinal obstruction.Methods A retrospective analysis was performed on perioperative clinical data of 57 cases of intestinal obstruction undergoing surgical treatment and admitted to our department from January 2010 to December 2015.Results Fifty-seven patients aged 70-105 years old (mean 78.3±7.3).Various complications occurred in 24 cases (42.1%,48 times),including 9 cases of lung infection,3 cases of intestinal obstruction,6 cases of arrhythmia,11 cases of wound infection,2 cases of acute renal failure and 17 cases of hypoalbuminemia.Operative complications commonly occurred in the patients concomitant with preoperative hypoproteinemia,hyperglycemia,nutritional insufficiency and long operative time,and age,cardiocerebrovascular diseases,disturbance of water and electrolyte and acid-base imbalance had no significant influence on the operative complications.Conclusions The postoperative complications are caused by many factors.Underlying diseases and poor health were the characteristics of elderly patients with intestinal obstruction.A comprehensive assessment of the condition before surgery and to improve the treatment of complications can reduce the incidence of surgical complications.