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JAMA Surg:患者虚弱与门诊术后并发症

2017-10-14 zhangfan MedSci原创

研究认为,对于普通门诊手术,虚弱与围手术期发病率增加有关,与年龄、麻醉类型和其他合并症无关。外科医生选择门诊手术时机时应该考虑到患者的虚弱性而不是年龄

虚弱是生理异常的重要指标,与择期和急诊外科手术的发病率和死亡率有关,与年龄无关。近日研究人员考察了门诊普通外科手术中的虚弱与患者预后的关系。

研究人员考察了2007-2010年,40岁以上患者接受疝、乳腺、甲状腺或甲状旁腺手术门诊术后的预后情况,总计140828名患者参与。主要终点是国家外科质量改进计划虚弱指数与围手术期发病率的关系。

参与者平均年龄59.3岁,女性患者80147人,其中疝手术患者71455名、乳腺手术患者51267人、甲状腺或甲状旁腺手术患者18106人。所有患者中,2457人 (1.7%)出现术后并发症,971人出现(0.7%)严重术后并发症,虚弱指数与并发症正相关。对年龄、性别、种族、麻醉类型、吸烟、肾功能衰竭、皮质类固醇使用调整后,多变量分析显示,中等虚弱指数(0.18-0.35分,相当于2-3项虚弱指标)增加各类(OR,1.70,95% CI,1.54-1.88; P<0.001)和严重(2.00,95% CI,1.72-2.34; P<0.001)术后并发症风险;高虚弱指数(≥0.36,超过4项虚弱指标),显著增加各类(OR,3.35,95% CI, 2.52-4.46; P<0.001)和严重(3.95,95% CI,2.65-5.87; P<0.001)术后并发症风险。麻醉与局部麻醉监测是唯一可变并发症减少协变量,调整后的比值比为0.66。

研究认为,对于普通门诊手术,虚弱与围手术期发病率增加有关,与年龄、麻醉类型和其他合并症无关。外科医生选择门诊手术时机时应该考虑到患者的虚弱性而不是年龄。

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    2018-03-19 owlhealth

    不错耶.学习了

    0

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    2018-08-26 丁鹏鹏
  3. [GetPortalCommentsPageByObjectIdResponse(id=297603, encodeId=d3b629e603a3, content=不错耶.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Mon Mar 19 07:01:47 CST 2018, time=2018-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757863, encodeId=c9be1e578639f, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Sun Aug 26 11:44:00 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252999, encodeId=ba87252999ef, content=好的.谢谢分享下.mark, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/mzZkwf53jx0oribz8WkmVTPTSib4iaRMXz6nkEOaqWPjgyYWQoLa8J2WCicWvb8SrhhZz5sgUcwmQnMQ1lJcA7Fhxg/0, createdBy=9b182084756, createdName=yunger, createdTime=Sun Oct 15 06:51:03 CST 2017, time=2017-10-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252852, encodeId=7f2025285283, content=henhao, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=353a2047758, createdName=137****9095, createdTime=Sat Oct 14 13:21:17 CST 2017, time=2017-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252833, encodeId=10fd252833c4, content=不错的.学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Sat Oct 14 12:19:01 CST 2017, time=2017-10-14, status=1, ipAttribution=)]
    2017-10-15 yunger

    好的.谢谢分享下.mark

    0

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    2017-10-14 137****9095

    henhao

    0

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    2017-10-14 中医痴

    不错的.学习了.谢谢分享!

    0

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