| 谢健铖,吴德华,温晖,蒋恺,张俊华,左顺庆.围手术期医疗时空拓展服务对高龄患者手术近期预后影响的大样本回顾性研究[J].老年医学与保健,2025,31(6):1504-1510,1517 |
| 围手术期医疗时空拓展服务对高龄患者手术近期预后影响的大样本回顾性研究 |
| Large retrospective study on effects of perioperative medical spatiotemporal expansion service on short-term prognosis of advanced age patients undergoing surgery |
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| DOI：10.3969/j.issn.1008-8296.2025.06.018 |
| 中文关键词: 高龄老人 围手术期 医疗服务模式 预后 |
| 英文关键词: advanced age perioperative period medical care model prognosis |
| 基金项目:2024ZDXK0050:上海市卫生健康系统重点学科建设项目;2023SJKJGG37:松江区科技攻关项目;24SJYXZDA04:松江区新一轮医学重点学科建设项目 |
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| 中文摘要: |
| 目的 探讨"围手术期医疗时空拓展服务"模式对高龄患者手术近期预后的影响.方法 回顾性分析上海交通大学医学院附属松江医院2020 年1 月1 日至2025 年2 月8 日行非心脏非脑外科择期手术的高龄患者临床资料,按照"围手术期时空拓展服务"模式完成的1 201 例为实验组,按照传统模式完成的1 274 例为对照组,进一步通过倾向评分匹配法匹配患者后,实验组和对照组均为1 080 例.比较2 组患者重症监护室入住率、入住时间、总住院时间、术后院内并发症和死亡情况,以及出院后 6 个月内死亡情况.结果 实验组和对照组患者 ASA分级构成比差异有统计学意义(P＜0.01).与对照组比较,实验组有更多的患者采用了联合麻醉(28.2%比 4.6%,P＜0.01),更少的患者采用了区域阻滞麻醉(14.0%比42.6%,P＜0.01).与对照组比较,实验组患者术中出血量更少(中位数:30 mL比50 mL,P＜0.01),手术延期率更低(12%比70%,P＜0.01),入住ICU比例更少(47.9%比53.8%,P＜0.01),入住ICU时间更短(中位数:1.0d比1.5 d,P＜0.01),住院时间更短[(12.51±8.06)d比(13.45±10.37)d,P＜0.01],术后并发症发生率更低(10.5%比14.4%,P＜0.01),以及院内死亡发生率更低(1.7%比3.0%,P＜0.05).2 组患者的麻醉时间、手术时间和出院后6 个月内死亡率均差异无统计学意义(P均＞0.05).结论 "围手术期医疗时空拓展服务"模式可改善80 岁以上高龄患者围手术期预后,对长期的影响仍有待进一步研究. |
| 英文摘要: |
| Objective To investigate the effects of the perioperative medical spatiotemporal expansion service model on the short-term prognosis of advanced age patients undergoing surgery.Methods A retrospective analysis was conducted on the clinical data of advanced age patients(≥80 years)who underwent elective non-cardiac and non-cerebral surgery in Songjiang Hospital Affiliated to Medical College of Shanghai Jiaotong University between January 1,2020,and February 8,2025.Patients treated under the perioperative medical spatiotemporal expansion service model(n=1 201)were assigned to experimental group(E group),while those treated under the traditional care model(n=1274)were assigned to control group(C group).After propensity score matching,1 080 patients were included in each group for comparison.The following outcomes were compared between the two groups:intensive care unit(ICU)admission rate,ICU length of stay,hospital length of stay,incidence of postoperative in-hospital complications,in-hospital mortality,and mortality within 6 months after discharge.Results There was a statistically significant difference in the composition ratio of ASA grades between the two groups(P＜0.01).Compared with the C group,a higher proportion of patients in the E group received combined anesthesia(28.2%vs 4.6%,P＜0.01),while fewer received regional anesthesia(14.0%vs 42.6%,P＜0.01).The E group also demonstrated significantly lower intraoperative blood loss(median:30 mL vs50 mL,P＜0.01),lower surgery postponement rate(12%vs 70%,P＜0.01),lower ICU admission rate(47.9%vs 53.8%,P＜0.01),shorter ICU stay(median:1.0 day vs1.5 days,P＜0.01),shorter total hospital stay(12.51±8.06 days vs 13.45±10.37 days,P＜0.01),lower incidence of postoperative complications(10.5%vs 14.4%,P＜0.01),and lower in-hospital mortality(1.7%vs 3.0%,P＜0.05).No statistically significant differences were observed between the two groups in anesthesia duration,surgical duration,and 6-month post-discharge mortality(all P＞0.05).Conclusion The perioperative medical spatiotemporal expansion service model may improve the perioperative prognosis of patients aged 80 years and older,but its long-term impact still needs further research. |
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