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題名 | Risk Factors Affecting Adverse Outcomes of Cardiac Surgery in Patients Aged 70 Years and Older=影響七十歲以上病人接受心臟手術發生不良預後的危險因子 |
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作 者 | 尹永成; 彭士魁; 黃仁宣; 謝政宏; 蔡宗杰; 施怡如; 彭士晏; | 書刊名 | 麻醉學雜誌 |
卷期 | 45:4 2007.12[民96.12] |
頁次 | 頁197-204 |
分類號 | 416.5 |
關鍵詞 | 術中併發症; 術後併發症; 70歲以上老年人; 心臟手術; 住院死亡率; 致病率; Intraoperative complications; Postoperative complications; Aged: 70 and over; Surgery: cardiac; Hospital mortality; Morbidity; |
語文 | 英文(English) |
中文摘要 | 背景:老年人口在台灣正快速地增加。接受心臟手術的高危險老年病人比例也急遽升高。我們分析了影響老年患者進行心臟手術後發生重大不良預後(死亡、併發症、延長加護病房住院)的危險因子。方法:我們回溯分析了952位在台中榮民總醫院接受心臟手術的病患。其中所有七十歲以上的病人被當作研究組(n=395), 其他的病人則當作參考組(n=557)。連續變項以t 檢定做比較,類別變項則用卡方檢定來比較。在單變項分析中相關於預後有顯著性(P<0.05)的危險因子再進入邏輯回歸的逐步分析來觀察各變項的影響力。結果:在七十歲以上的病人影響術後死亡率的因子包括腎功能、再次手術、心臟衰竭,和危急狀態。影響併發症發生的因子有腎功能、手術複雜性、心臟衰竭、慢性阻塞性肺病、和危急狀態。影響延長加護病房住院的因子有心臟衰竭、慢性阻塞性肺病、和危急狀態。結論:老年患者進行心臟手術的危險性是增加的,而某些因子在七十歲以上病人和七十歲以下病人身上則有不同的影響力。 |
英文摘要 | Background: The elderly segment of the population in Taiwan is increasing rapidly. According to the latest information from the Directorate-General of Budget, Accounting and Statistics, Executive Yuan, Taiwan, 1,553,367 civilians of the total population of 22,879,510 (6.8%) are seventy years old and older in 2007. The proportion of high-risk patients has increased dramatically owing to a greater number of elderly patients and increased number of average patients with heart diseases presenting for cardiac surgery. We analyzed the preoperative risk factors for in-hospital mortality, morbidity and the likelihood of prolonged intensive care unit (ICU) stay in elderly patients after cardiac surgery. Methods: We retrospectively studied 952 adult patients who received cardiac surgery during a three-year period (from August 1, 2004 to December 31, 2006) at Taichung Veterans General Hospital. Patients were divided into a control group and a study group. The study group (n=395) exclusively consisted of patients aged seventy or over while the rest of the patients under study served as reference group (n = 557). Continuous variables were compared using Student's t test, and categorical variables were compared using Pearson chi-square test. Variables associated with in-hospital mortality, major morbidity and prolonged ICU stay in univariate analysis with P <0.05 were entered into multivariate analysis using logistic regression with a stepwise forward selection procedure to determine independent variables and identify variables associated withmajor adverse outcomes. Results: Fifty-six (14.2%) patients died during their hospitalization in the study group and 46 (8.3%) in the reference group. Major mortality in the study group was 58.0% versus 39.7% in the reference group. The patients of the study group spent more days in the ICU than did patients of the reference group (8.7 ± 12.0 versus 6.1 ± 10.0 days, P < 0.05). In addition, 114 (28.9%) patients of the study group and 85 (15.3%) of the reference group spent more than 7 days in the ICU. Usingmultiple logistic regression analysis, risk factors affecting in-hospitalmortality in the study group include impairment of renal function, reoperation, congestive heart failure (CHF), catastrophic event. Impaired renal function, complexity of surgical procedure, CHF, chronic obstructive pulmonary disease (COPD) and catastrophic state were significant factors affecting morbidity in the study group. CHF, COPD and catastrophic event contributed to prolonged ICU stay in the study group. Conclusions: The perioperative risk of cardiac surgery increases in older patient groups, and some risk factors havedifferent influences onmortality, morbidity and ICU stay. Risk assessment in older cardiosurgical patients with convenient risk factors helps the clinicians to apply rational and cost-effective treatment strategies into practice. |
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