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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2011, Vol. 05 ›› Issue (04) : 347 -350. doi: 10.3877/cma.j.issn.1674-0793.2011.04.021

所属专题： 经典病例； 经典病例； 文献；

调查统计

消化道疾病患者951例围术期死亡病例调查
刘璐1, 来伟1, 刘伟燕1, 伍衡1, 曾育杰1, 周军1, 陈双1, 褚忠华1,†()   
  1. 1. 510120　广州，中山大学孙逸仙纪念医院胃肠外科
  • 收稿日期:2011-01-06 出版日期:2011-08-01
  • 通信作者: 褚忠华
  • 基金资助:
    教育部新教师基金(200805581153); 国家青年科学基金项目(81001306)

Investigation of mortality in general surgery operation during perioperative period

Lu LIU1, Wei LAI1, Wei-yan LIU1, Heng WU1, Yu-jie ZENG1, Jun ZHOU1, Shang CHEN1, Zhong-hua CHU1,†()   

  1. 1. Gastrointestinal surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
  • Received:2011-01-06 Published:2011-08-01
  • Corresponding author: Zhong-hua CHU
  • About author:
    Corresponding author: CHU Zhong-hua, Email:
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刘璐, 来伟, 刘伟燕, 伍衡, 曾育杰, 周军, 陈双, 褚忠华. 消化道疾病患者951例围术期死亡病例调查[J]. 中华普通外科学文献(电子版), 2011, 05(04): 347-350.

Lu LIU, Wei LAI, Wei-yan LIU, Heng WU, Yu-jie ZENG, Jun ZHOU, Shang CHEN, Zhong-hua CHU. Investigation of mortality in general surgery operation during perioperative period[J]. Chinese Archives of General Surgery(Electronic Edition), 2011, 05(04): 347-350.

目的

分析我院胃肠外科患者围术期死亡的高危因素，探讨降低围术期死亡率的方法。

方法

回顾性研究2005年1月至2010年1月收治的951例手术患者的临床资料，对其中19例围术期死亡病例的临床资料进行统计学分析。

结果

951例手术患者围术期死亡率为2.0%，主要影响因素是高龄、恶性肿瘤、术前高血压及冠心病以及术后低蛋白血症、呼吸系统衰竭及肾功能不全。并且低体温、代谢性酸中毒和凝血功能障碍严重影响术后生存率。

结论

强化围术期患者高危因素的积极处理并结合损伤控制外科理念，对于降低死亡率具有重要的意义。

关键词: 围手术期, 死亡率, 死亡三联症
Objective

To analyze the main causes of death and explore the methods to decrease the mortality of general surgery operation during perioperative period.

Methods

A retrospective analysis of the clinical data from 2005 to 2010 was performed in 951 patients of general surgery operation. The risk factors influencing perioperative mortality were statistical analyzed of 19 death cases.

Results

The total perioperative mortality was 2.0%. Four independent preoperative risk factors of mortality were age old than 65 years, malignant tumor, hypertension, coronary heart disease. Three independent risk factors of morbidity were found: hypoalbuminemia, respiratory distress, and renal failure. The postoperative survival rate was tightly related to hypothermia, metabolic acidosis, and coagulation disorders.

Conclusion

Improving the perioperative management of high risks and using damage control surgery are very important for decreasing the perioperative mortality in general surgery operation.

Key words: Perioperative period, Mortality, Lethal triad of death
表1 951例胃肠外科手术患者的一般资料及术前合并症与围术期死亡率关系
项目 例数 死亡例数 P值
年龄 ? ? ?
? ≥65岁 312 15 <0.01
? <65岁 639 4 ?
性别 ? ? ?
? 男 532 11 ?
? 女 419 8 ?
恶性肿瘤 323 15 <0.01
合并症 ? ? ?
? 高血压 133 11 <0.01
? 冠心病/心肌缺血 65 7 <0.05
? 糖尿病 117 7 ?
? 慢性支气管炎/肺气肿病史 13 1 ?
表2 951例患者术后并发症与围术期死亡率关系
并发症 例数 死亡例数 P值
低蛋白血症 261 12 <0.01
急性肾功能不全 12 8 <0.01
呼吸衰竭 13 4 <0.01
低血容量性休克 122 6 ?
肺部感染 130 6 ?
心功能不全 98 5 ?
1
Tekkis PP, Kessaris N, Kocher HM, et al. Evaluation of POSSUM and p-POSSUM scoring systems in patients undergoing colorectal surgery. Br J Surg, 2003, 90(3): 340-345.
2
Nickelsen TN, Jorgensen T, Kronborg O. Thirty-day mortality after surgery for colorectal cancer in Denmark. Colorectal Dis, 2005, 7(5): 500-506.
3
Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume outcome relationship. Arch Surg, 2007, 142(1): 23-31.
4
Davila JA, Rabeneck L, Berger DH, et al. Postoperative 30-day mortality following surgical resection for colorectal cancer in veterans: changes in the right direction. Dig Dis Sci, 2005, 50(9): 1722-1728.
5
Heriot AG, Tekkis PP, Smith JJ, et al. Prediction of postoperative mortality in elderly patients with colorectal cancer. Dis Colon Rectum, 2006, 49(6): 816-824.
6
Rosella AM, Daley J, Henderson WG, et al. Multifactor risk index for predicting postoperative respiratory failure in men after major no cardiac Surgery. Ann Surg, 2000, 232(3): 242-253.
7
Leung E, Ferjani AM, Stellard N, et al. Predicting post-operative mortality in patients undergoing colorectal surgery using P-POSSUM and CR-POSSUM scores: a prospective study. Int J Colorectal Dis, 2009, 24(12): 1459-1464.
8
K Quach S, Hennessy DA, Faris P, et al. A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients. BMC Health Serv Res, 2009, 9(1): 129.
9
Clark AJ, Stockton D, Elder A, et al. Assessment of outcome af ter colorectal cancer resection in elderly as a rationale for screening and early detection. Br J Surg, 2004, 91(10): 1345-1351.
10
Alves A, Panis Y, Mathieu P, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg, 2005, 140(3): 278-283.
11
Gibbs J, Cull W, Henderson W, et al. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg, 1999, 134(1): 36-42.
12
Beuran M，Iordache FM. Damage control surgery--new concept or reenacting of a classical idea? J Med Life, 2008, 1(3): 247-253.
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