老年患者围术期死亡相关因素的Logistic回归分析
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摘要
目的采用Logistic回归分析,探讨老年患者术中低血压及其他潜在因素与围术期死亡的相关性。方法收集我院2007年1月至2017年8月接受外科手术、年龄≥65岁的老年患者26 758例,病例分为两组:观察组156例(死亡病例)和对照组312例(按存活∶死亡为2∶1随机纳入)。利用麦迪斯顿麻醉信息系统采集患者术中血压以及系列手术相关信息,对其与老年患者围术期死亡的相关性进行单因素和多因素Logistic回归分析。结果单因素Logistic回归分析结果提示:平均动脉压(MAP)≤65 mm Hg以及收缩压(SBP)≤120 mm Hg的各区段血压、年龄、ASA分级、心功能分级、实施全麻、术前合并症、手术类型、术中使用血管活性药物、术中输血均可能与老年患者围术期死亡相关(P<0.05)。多因素Logistic回归分析结果提示:术中低血压(60 mm Hg1)。结论老年手术患者术中MAP≤65 mm Hg,随持续时间的延长,将增加术后死亡率的风险;年龄、ASA分级、术前合并冠心病或恶性肿瘤、颅脑手术及术中输血量是老年患者围术期死亡的高危因素。
Objective To explore the correlation of intraoperative hypotension and other risk factors with perioperative death in elderly patients.Methods We reviewed the clinical data of 26 758 patients aged65 years or above who underwent surgery in our hospital between January,2007 and August,2017,and selected 156 patients with perioperative death(observation group) and 312 surviving patients(control group,selected randomly from the total surviving patients) for this study.The intraoperative blood pressure and surgical data of the enrolled patients were collected using the Maddie Ston anesthesia information system.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for perioperative mortality in the elderly patients.Results The results of univariate logistic regression analysis suggested a mean arterial blood pressure(MAP) ≤65 mm Hg with a systolic blood pressure(SBP) ≤120 mm Hg,age,ASA classification,cardiac function classification,general anesthesia,preoperative complications,surgical types,intraoperative use of vasoactive drugs,and intraoperative blood transfusion were all significantly correlated with perioperative mortality in the elderly patients(P<0.05).Multivariate logistic regression analysis revealed that intraoperative hypotension(a MAP between 61 and 65 mm Hg) was a high-risk factor for perioperative death in these patients,and the perioperative mortality rate could be increased when the cumulative hypotention time approached 8% of the total operative time.The other high-risk factors associated with perioperative mortality in the elderly patients included age,ASA classification,pre-existing coronary heart disease or malignant neoplasms,craniocerebral surgery and intraoperative blood transfusion(OR>1).Conclusion Prolonged intraoperative hypotension(with a MAP below 65 mm Hg) is correlated with an increased risk of perioperative death in elderly patients.Age,ASA classification,coronary heart disease or malignant tumor,craniocerebral surgery and intraoperative blood transfusion are all high-risk factors for perioperative death in elderly patients.
Objective To explore the correlation of intraoperative hypotension and other risk factors with perioperative death in elderly patients.Methods We reviewed the clinical data of 26 758 patients aged65 years or above who underwent surgery in our hospital between January,2007 and August,2017,and selected 156 patients with perioperative death(observation group) and 312 surviving patients(control group,selected randomly from the total surviving patients) for this study.The intraoperative blood pressure and surgical data of the enrolled patients were collected using the Maddie Ston anesthesia information system.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for perioperative mortality in the elderly patients.Results The results of univariate logistic regression analysis suggested a mean arterial blood pressure(MAP) ≤65 mm Hg with a systolic blood pressure(SBP) ≤120 mm Hg,age,ASA classification,cardiac function classification,general anesthesia,preoperative complications,surgical types,intraoperative use of vasoactive drugs,and intraoperative blood transfusion were all significantly correlated with perioperative mortality in the elderly patients(P<0.05).Multivariate logistic regression analysis revealed that intraoperative hypotension(a MAP between 61 and 65 mm Hg) was a high-risk factor for perioperative death in these patients,and the perioperative mortality rate could be increased when the cumulative hypotention time approached 8% of the total operative time.The other high-risk factors associated with perioperative mortality in the elderly patients included age,ASA classification,pre-existing coronary heart disease or malignant neoplasms,craniocerebral surgery and intraoperative blood transfusion(OR>1).Conclusion Prolonged intraoperative hypotension(with a MAP below 65 mm Hg) is correlated with an increased risk of perioperative death in elderly patients.Age,ASA classification,coronary heart disease or malignant tumor,craniocerebral surgery and intraoperative blood transfusion are all high-risk factors for perioperative death in elderly patients.
引文
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[3]GU W J,HOU B L,KWONG J S W,et al.Association between intraoperative hypotension and 30-day mortality,major adverse cardiac events,and acute kidney injury after non-cardiac surgery:A meta-analysis of cohort studies[J].Int J Cardiol,2018,258:68-73.DOI:10.1016/j.ijcard.2018.01.137.
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[9]VAN WAES J A,VAN KLEI W A,WIJEYSUNDERA D N,et al.Association between intraoperative hypotension and myocardial injury after vascular surgery[J].Anesthesiology,2016,124(1):35-44.DOI:10.1097/ALN.0000000000000922.
[10]BIJKER J B,PERSOON S,PEELEN L M,et al.Intraoperative hypotension and perioperative ischemic stroke after general surgery:a nested case-control study[J].Anesthesiology,2012,116(3):658-664.DOI:10.1097/ALN.0b013e3182472320.
[11]MONK T G,BRONSERT M R,HENDERSON W G,et al.Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery[J].Anesthesiology,2015.123(2):307-319.DOI:10.1097/ALN.0000000000000756.
[12]WESSELINK E M,KAPPEN T H,TORN H M,et al.Intraoperative hypotension and the risk of postoperative adverse outcomes:a systematic review[J].Br J Anaesth,2018,121(4):706-721.DOI:10.1016/j.bja.2018.04.036.
[13]FECHO K,LUNNEY A T,BOYSEN P G,et al.Postoperative mortality after inpatient surgery:Incidence and risk factors[J].Ther Clin Risk Manag,2008,4(4):681-688.
[2]陆文良,KUMAR D S,郑松柏,et al.住院老年手术患者围术期并发症与死亡情况分析[J].中华老年医学杂志,2013,32(12):1319-1321.DOI:10.3760/cma.j.issn.0254-9026.2013.12.017.LU W L,KUMAR D S,ZHENG S B,et al.Analysis of perioperative complications and mortality in hospitalized elderly surgical patients[J].Chin J Geriatr,2013,32(12):1319-1321.DOI:10.3760/cma.j.issn.0254-9026.2013.12.017.
[3]GU W J,HOU B L,KWONG J S W,et al.Association between intraoperative hypotension and 30-day mortality,major adverse cardiac events,and acute kidney injury after non-cardiac surgery:A meta-analysis of cohort studies[J].Int J Cardiol,2018,258:68-73.DOI:10.1016/j.ijcard.2018.01.137.
[4]WESSELINK E M,KAPPEN T H,VAN KLEI W A,et al.Intraoperative hypotension and delirium after on-pump cardiac surgery[J].Br J Anaesth,2015,115(3):427-433.DOI:10.1093/bja/aev256.
[5]VERNOOIJ L M,VAN KLEI W A,MACHINA M,et al.Different methods of modelling intraoperative hypotension and their association with postoperative complications in patients undergoing non-cardiac surgery[J].Br J Anaesth,2018.120(5):1080-1089.DOI:10.1016/j.bja.2018.01.033.
[6]BIJKER J B,VAN KLEI W A,VERGOUWE Y,et al.Intraoperative hypotension and 1-year mortality after noncardiac surgery[J].Anesthesiology,2009,111(6):1217-1226.DOI:10.1097/ALN.0b013e3181c14930.
[7]WALSH M,DEVEREAUX P J,GARG A X,et al.Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery:toward an empirical definition of hypotension[J].Anesthesiology,2013,119(3):507-515.DOI:10.1097/ALN.0b013e3182a10e26.
[8]XUE F S,LI R P,WANG S Y.Association of intraoperative hypotension with postoperative acute kidney and myocardial injuries in noncardiac surgery patients[J].Anesthesiology,2014,120(5):1278-1280.DOI:10.1097/ALN.0000000000000168.
[9]VAN WAES J A,VAN KLEI W A,WIJEYSUNDERA D N,et al.Association between intraoperative hypotension and myocardial injury after vascular surgery[J].Anesthesiology,2016,124(1):35-44.DOI:10.1097/ALN.0000000000000922.
[10]BIJKER J B,PERSOON S,PEELEN L M,et al.Intraoperative hypotension and perioperative ischemic stroke after general surgery:a nested case-control study[J].Anesthesiology,2012,116(3):658-664.DOI:10.1097/ALN.0b013e3182472320.
[11]MONK T G,BRONSERT M R,HENDERSON W G,et al.Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery[J].Anesthesiology,2015.123(2):307-319.DOI:10.1097/ALN.0000000000000756.
[12]WESSELINK E M,KAPPEN T H,TORN H M,et al.Intraoperative hypotension and the risk of postoperative adverse outcomes:a systematic review[J].Br J Anaesth,2018,121(4):706-721.DOI:10.1016/j.bja.2018.04.036.
[13]FECHO K,LUNNEY A T,BOYSEN P G,et al.Postoperative mortality after inpatient surgery:Incidence and risk factors[J].Ther Clin Risk Manag,2008,4(4):681-688.