腹部择期手术后患者电解质代谢变化与术后并发症的相关性:回顾性分析

摘要

Objective To investigate the changes of electrolyte metabolism in patients undergoing moderate elective abdominal operation,and explore its relationship with postoperative complications.Methods The clinical data of 1117 inpatients (age ≥ 18 years) who had undergone moderate elective abdominal operation in the Department of General Surgery of Beijing Hospital from January 1,2011 to December 31,2011 were retrospectively analyzed.They received postoperative fasting for ≥ 3 days,and the preoperative liver function and renal function were normal.The perioperative electrolyte changes and clinical outcomes were recorded.For patients with normal preoperative electrolytes but abnormal postoperative electrolytes,its potential correlations with the postoperative infections and total complications were analyzed.Results The rates of abnormal postoperative electrolytes were as follows:potassium,24.1％ ; sodium,6.4％ ; chloride,27.6％ ; calcium,61.7％ ; magnesium,16.3％ ; and phosphorus,71％.The vast majority of ion levels were below the normal levels.The total complication rate was 19.7％ and the postoperative infection rate was 17.19％.Univariate logistic regression analysis showed that the postoperative total and infective complications were significantly associated with the increased (P =0.007) or decreased (P =0.007) serum potassium,the decreased serum sodium (P =0.016),the decreased serum phosphorus (P =0.004),and the decreased magnesium (P =0.049).Conclusions Electrolyte decrease is common after moderate elective abdominal operations.There is a certain correlation between postoperative electrolyte decrease and postoperative complications.Therefore,attention should be paid to maintain electrolyte balance during the perioperative period.%目的 调查腹部择期手术患者术后电解质代谢变化,及与术后并发症的相关性.方法 回顾性调查2011年1月1日至12月31日北京医院普外科接受腹部择期手术、年龄≥18岁；术后禁食≥3 d；术前肝肾功能大致正常的住院患者1117例,回顾性分析围手术期电解质变化和临床结局指标,对术前电解质正常且术后异常的病例,分析其与术后感染并发症及总并发症的相关性.结果 术后出现电解质异常的比例为钾(24.1％)、钠(6.4％)、氯(27.6％)、钙(61.7％)、镁(16.3％)、磷(71.0％),绝大多数为离子水平低于正常；总并发症为19.70％,其中感染并发症17.19％；单因素Logistic回归分析显示,术后总并发症和感染并发症发生与血清钾离子升高(P=0.007)和减低(P =0.007)、钠离子减低(P=0.016)、磷离子减低(P=0.004)及镁离子减低(P =0.049)显著相关.结论 腹部择期手术后电解质降低较为常见,与术后并发症存在一定关联,应重视维护围手术期电解质平衡.