老年患者围术期死亡相关因素的Logistic回归分析

赵本惠; 陈倩; 何心海; 陈星同; 易斌; 甯交琳; 鲁开智; 顾健腾

doi:10.16016/j.1000-5404.201808164

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老年患者围术期死亡相关因素的Logistic回归分析

临床医学 | 更新时间：2026-01-09

- 老年患者围术期死亡相关因素的Logistic回归分析
- Logistic regression analysis of risk factors for perioperative mortality in elderly patients
- 第三军医大学学报 2019年41卷第2期页码：148-152
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
  
  [ 顾健腾，E-mail：gjt1976@163.com GU Jianteng, E-mail: gjt1976@163.com
- 基金信息：
  
  陆军军医大学第一附属医院院管课题(SWH2016JSTSYB-55)
- DOI：10.16016/j.1000-5404.201808164
  中图分类号： R363.273;R544.2;R619.9
- 收稿：2018-08-20，
  
  修回：2018-09-20，
  
  纸质出版：2019-01-30
- 稿件说明：
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赵本惠, 陈倩, 何心海, 等. 老年患者围术期死亡相关因素的Logistic回归分析[J]. 第三军医大学学报, 2019,41(2):148-152.

Benhui ZHAO, Qian CHEN, Xinhai HE, et al. Logistic regression analysis of risk factors for perioperative mortality in elderly patients[J]. Journal of Third Military Medical University, 2019, 41(2): 148-152.
赵本惠, 陈倩, 何心海, 等. 老年患者围术期死亡相关因素的Logistic回归分析[J]. 第三军医大学学报, 2019,41(2):148-152. DOI： 10.16016/j.1000-5404.201808164.

Benhui ZHAO, Qian CHEN, Xinhai HE, et al. Logistic regression analysis of risk factors for perioperative mortality in elderly patients[J]. Journal of Third Military Medical University, 2019, 41(2): 148-152. DOI： 10.16016/j.1000-5404.201808164.

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 mmHg以及收缩压(SBP)≤120 mmHg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(

0.05)。多因素Logistic回归分析结果提示：术中低血压(60 mmHg

MAP≤65 mmHg)是老年患者围术期死亡的高危因素，其累计持续时间占总手术时间大于7.84%时增加老年患者围术期死亡率；与老年患者围术期死亡相关的其他高危因素包括年龄、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(

1)。

结论

老年手术患者术中MAP≤65 mmHg，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。

Abstract

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 aged 65 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 mmHg with a systolic blood pressure (SBP) ≤120 mmHg

age

ASA classification

cardiac function classification

general anesthesia

preoperative complications

surgical types

intraoperative use of vasoactive drugs

and intraoperative bl

ood transfusion were all significantly correlated with perioperative mortality in the elderly patients (

0.05). Multivariate logistic regression analysis revealed that intraoperative hypotension (a MAP between 61 and 65 mmHg) 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 (

1).

Conclusion

Prolonged intraoperative hypotension (with a MAP below 65 mmHg) 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.

关键词

Keywords

references

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